持续性不卧床式腹膜透析患者腹腔内使用万古霉素的治疗药物监测

Therapeutic Drug Monitoring for Vancomycin in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis

目的:对持续性不卧床式腹膜透析患者腹腔内使用万古霉素进行监测,为万古霉素用药方案调整提供依据。方法:6名持续性不卧床式腹膜透析腹膜炎患者腹腔内使用万古霉素后,采集不同时间点的血浆和腹膜透析液样品,用高效液相色谱法测定血药浓度和腹膜透析液中药物浓度。结果:万古霉素加入腹膜透析液中给药的生物利用度为93.27%。给药后10h(第1次腹膜透析液放出来前)患者血药浓度约为21.71μg·mL-1,最低血药浓度(下次给药前)为11.39μg·mL-1;腹膜透析液中药物谷浓度为5.62μg·mL-1。结论:万古霉素加入腹膜透析液中给药,能够确保万古霉素有效吸收,且使腹腔局部保持有效的抑菌浓度,未造成万古霉素蓄积。

OBJECTIVE：To monitor the application of vancomycin in patients undergoing undergoing continuous ambulatory peritoneal dialysis（CAPD） in order to provide reference for the adjustment of therapeutic regimen of vancomycin.METHODS：6 patients undergoing CAPD were enrolled and received vancomycin.Plasma samples and peritoneal dialysis solution were collected at different time points.Plasma concentrations of vancomycin and drug concentration of peritoneal dialysis solution were determined by HPLC.RESULTS：The bioavailability of vancomycin after added into peritoneal dialysis solution was 93.27%.Plasma concentration of vancomycin 10 h after administration（before leaking peritoneal dialysis solution at the first time） was 21.71 μg·mL-1 and the lowest plasma concentration of vancomycin（before the next administation） was 11.39 μg·mL-1.The valley concentration of vancomycin in peritoneal dialysis solution was 5.62 μg·mL-1.CONCLUSION：The intraperitoneal administration allows a desired absorption of vancomycin and maintains an effective inhibitory concentration in peritoneal cavity.Present therapeutic regimen doesn＇t result in accumulation of vancomycin.