万古霉素在我院肝移植患者中的治疗药物监测及临床应用分析

Therapeutic Drug Monitoring and Clinical Utilization of Vancomycin in Liver Transplantation Recipients in Our Hospital

目的:评价万古霉素在我院肝移植患者中的治疗药物监测情况,治疗前、后肾功能变化与影响血药浓度的相关因素。方法:采用回顾性方法,对我院器官移植中心2003年1月-2009年4月肝移植术后应用万古霉素的64例患者的血药浓度监测数据、细菌培养、药敏试验及应用万古霉素前、后的肾功能变化情况进行分析。结果:64例肝移植患者的396例/次血药浓度监测结果显示,平均谷浓度为(16.41±9.20)mg·L-1;谷浓度在5-10mg·L-1的占16.92%,>10mg·L-1的占73.48%,<5mg·L-1的占9.60%。谷浓度>10mg·L-1时,患者的肾功能与应用万古霉素治疗前比较差异有统计学意义(P<0.05)。经回归分析,影响万古霉素血药浓度的相关因素依次为剂量/体重、肌酐、年龄、丙氨酸氨基转移酶(P<0.05)。结论:万古霉素在肝移植患者中的治疗浓度较高;随着血药浓度升高应密切监测肾功能的变化;临床疗效及药物利用指数均表明我院该药的应用是基本合理的。

OBJECTIVE：To evaluate the drug therapy of vancomycin in liver transplantation recipients, the change of kidney function and influencing factors of blood concentration. METHODS： The blood concentration monitoring data, bacterial culture, drug sensitivity test, kidney function change before and after administration in 64 liver transplantation recipients in organ transplantation center of our hospital from Jan. 2003 to Apr. 2009 were analyzed retrospectively. RESULTS： 396 times of blood concentration monitoring results of 64 liver transplantation recipients showed that average trough concentration of vancomycin was （16.41±9.20） mg·L-1. The concentrations of 16.92% cases were 5～10 mg·L-1, that of 73.48% were more than 10 mg·L-1 and 9.60% were lower than 5 mg·L-1. The renal function showed significant differences before and after administration at trough concentration more than 10 mg·L-1（P〈0.05）. Through regression analysis, the main influencing factors of blood concentration were dose/body weight,Cr,age,ALT in order （P〈0.05）. CONCLUSION： Clinical achievable concentration of vancomycin is high relatively in liver transplantation recipients. Kidney function change should be monitored closely with blood concentration of vancomycin increasing. Clinical efficacy and DUI show that clinical application of vancomycin in our hospital is almost reasonable.