摘要
目的分析万古霉素血药浓度危急值及急性肾损伤(acute kidney injury,AKI)的相关影响因素。方法收集2020年1月至2021年12月期间万古霉素谷浓度出现危急值报告的病例,对患者原患疾病,病原学检查,治疗前、危急值出现时、停药/减量后的肾功能指标尿素氮(Bun)和肌酐(Cr),危急值时间,用药情况,疗效等相关临床资料进行统计分析。结果研究期间共136例患者合并反馈危急值报告241例次,万古霉素谷浓度的平均危急值为29.40μg·mL^(-1);患者平均年龄为(66.77±16.27)岁,主要收治科室为重症医学科、肾移植中心以及肾内科;感染部位以肺部感染比例最高,39例(28.67%);病原学送检率为99.26%,其中91例(66.91%)培养结果为2种及以上病原体;使用万古霉素后出现危急值的时间为(4.89±2.72)d,用药疗程为(8.11±5.03)d;113例(83.09%)患者联用一种以上抗菌药物,包括亚胺培南西司他丁钠、替加环素等;反馈危急值报告时,33例(24.26%)患者发生AKI,患者的Bun和Cr水平相较于使用万古霉素前出现显著升高(P<0.05),及时停药/调整药物剂量后,Bun和Cr水平出现不同程度的降低;单因素方差分析比较AKI组与非AKI组,发现万古霉素谷浓度、联合使用亚胺培南西司他丁钠在影响肾功能指标方面差异有统计学意义(P<0.05);在接受万古霉素治疗过程中,46例(33.82%)痊愈,25例(18.38%)出现好转,65例(47.80%)无效。结论合并使用亚胺培南西司他丁钠的患者更易诱发万古霉素相关AKI,监测万古霉素血药浓度危急值有助于及时调整给药方案,提高万古霉素用药安全。
Objective To analyze the critical value of vancomycin blood concentration and related influencing factors for acute kidney injury(AKI).Methods From January 2020 to December 2021,the patient cases with critical values of vancomycin trough concentration were collected.The clinical data of the patients were analyzed,including the original diseases,etiological examination,renal function indicators of urea nitrogen(Bun)and creatinine(Cr)before the treatment,and after drug withdrawal/dose reduction time when the critical values appeared,the critical values,time of medication,and efficacy.Results Totally 136 patients complicated 241 feedback critical value reports during the study period,and the critical value of vancomycin trough concentration was 29.40μg·mL^(-1) on average.The mean age of the patients was(66.77±16.27)years.The main departments included Critical Care Department,Kidney Transplantation Center and Nephrology Department.The proportion of lung infection was the highest(39 patients,28.67%).The pathogen detection rate was 99.26%,among which 91 patient cases(66.91%)had cultured two or more pathogens.The time of critical value of vancomycin was(4.89±2.72)days,and the course of vancomycin was(8.11±5.03)days.Totally 113 patients(83.09%)received more than one antibiotics,including imipenem cilastatin sodium,tigecycline,etc.When the critical value was reported,33 patients(24.26%)developed AKI,and the levels of Bun and Cr of patients were significantly increased compared with before vancomycin administration(P<0.05).The levels of Bun and Cr were decreased to varying degrees after timely drug withdrawal/dose adjustment.Single factor analysis of variance was used to compare the AKI group and non-AKI group.The trough concentration of vancomycin and the combination of imipenem and cilastatin sodium had significant effects on the renal function indexes(P<0.05).In the course of vancomycin treatment,46 patients(33.82%)recovered,25(18.38%)improved,and 65(47.80%)had no effect.Conclusion Patients treated with imipenem and cilastatin sodium combination are more likely to develop vancomycin-related AKI.Monitoring the critical value of vancomycin blood concentration helps adjust the dosing regimen in time and improve the safety of vancomycin use.
作者
高航
邹素兰
蒋艳
凌静
董露露
杨旭萍
胡楠
GAO Hang;ZOU Su-lan;JIANG Yan;LING Jing;DONG Lu-lu;YANG Xu-ping;HU Nan(Department of Pharmacy,The First People’s Hospital of Changzhou,Changzhou Jiangsu 213003)
出处
《中南药学》
2023年第9期2482-2486,共5页
Central South Pharmacy
基金
常州市科技基础设施建设计划-常州市临床药学重点实验室(No.CM20223005)
常州市“十四五”卫生健康高层次人才培养工程(No.KY20221389)。
关键词
万古霉素
治疗药物监测
危急值
急性肾损伤
vancomycin
therapeutic drug monitoring
critical value
acute kidney injury