ICU患者万古霉素血药浓度的监测

Application of therapeutic drug monitoring of vancomycin in ICU patients

目的：建立高效液相色谱（HPLC）法快速测定人血浆中万古霉素浓度的方法,监测ICU患者治疗药物的浓度。方法：色谱柱为Waters的Xbridge柱（4.6 mm×150 mm,5μm）;流动相为25 mmol·L^-1磷酸二氢钾-甲醇（86：14,p H=2.4）,流速为1.0 m L·min^-1,紫外检测波长为236 nm,进样量为20L,柱温为40℃。结果：万古霉素浓度在1～100 mg·L^-1内线性关系良好（r=0.9992）,定量下限为1.0 mg·L^-1,日内、日间精密度相对标准偏差（RSD）分别为5.83%和6.06%,提取回收率为79.71%。所监测的28例患者血样中,有12例患者首次万古霉素谷浓度在10～20 mg·L^-1之间,有17例治疗结果为有效,总有效率为60.7%。结论：HPLC法简便、灵敏、准确、快速、重复性好,可用于ICU患者万古霉素的血药浓度监测。万古霉素用药后血药浓度个体差异较大,临床需要监测结果,为ICU患者制定合理的个体化给药方案。

Objective： To establish a HPLC method for fast determination of vancomycin in serum andusing the method for monitoring ICU patients＇ therapeutic drug concentration. Methods： HPLC analysis was performed using a Water＇ Xbridge column （4.6 mm×150 mm, 5 μm）. The mobile phase was KH2PO4 （25 mmolo L-X）-methanol （86：14, pH=2.4）. The flow-rate was 1.0 mL·min^-1 and the detection wave length was 236 nm by UV. The injection volume was 20 pL and the temperature of column was 40 ℃. Results： The concentration range of vancomycin was 1-100 mg·L^-1 while the calibration curve showed good linearity （r=0.9992）, and the minimum limit of quantitation was 1.0 mg·L^-1. The relative standard deviations （RSD） of intra-day and inter-day were 5.83% and 6.06%, the extraction recovery was 79.71%. Twelve patients first blood valley concentration of vancomycin was between 10 and 20 mg·L^-1. There were 17 cases of the treatment for effective, total effective rate was 60.71%. Conclusion： The method is simple, sensitive, exact, rapid and good repeatability. It can be used for detecting the concentration of vancomycin in ICU patients. There is bigger individual difference in blood con- centration after giving Vancomycin. Clinical need monitoring results formulate reasonable individualized dosage regimen for ICU patients.