连续肾脏替代疗法对老年重症患者万古霉素血药浓度的影响

Influence of CRRT on trough concentration of vancomycin in critically ill elderly patients

目的:监测老年重症患者万古霉素血药浓度,评估接受连续肾脏替代疗法(CRRT)治疗后患者万古霉素谷浓度情况。方法:对48例老年重症患者用药48 h后万古霉素血药浓度进行检测,回顾并统计患者基本临床信息以及CRRT治疗情况。结果:CRRT组平均血药浓度为(21.34±10.74)mg/L,非CRRT组平均血药浓度为(29.01±9.16)mg/L(t=2.66,P=0.01),CRRT组与非CRRT组达到推荐血药浓度范围的患者均为16.67%,CRRT组与非CRRT组中分别有37.50%和4.17%的患者万古霉素谷浓度小于15 mg/L,谷浓度超过20 mg/L的患者分别占45.83%和79.17%(χ2=9.56,P=0.03)。CRRT组患者万古霉素血药浓度与白蛋白水平无相关关系,但是非CRRT组患者万古霉素血药浓度与白蛋白水平呈正相关。结论:老年重症患者万古霉素血药浓度普遍偏高,低蛋白血症可延长老年重症患者万古霉素半衰期。CRRT治疗可有效清除患者万古霉素,对接受万古霉素治疗的老年重症患者行血药浓度检测有助于药物使用的安全性和有效性评估。

Objective To elucidate the influence of continuous renal replacement therapy （CRRT） on trough concentration of vancomycin in critically ill elderly patients. Methods We detected the concentration of vancomycin in 48 critically ill elderly patients with/without CRRT 48 hours after receiving vancomycin treatment and reviewed the clinical characteristics of the patients. Results Tile trough concentration of CRRT group and non- CRRT group was （21.34 ± 10.74） mg/L and （29.01 ± 9.16） mg/L, respectively （t = 2.66, P = 0.01）. In CRRT and non-CRRT group, the trough concentration of 15 - 20 mg/L were both 16.67% but that of 〈 15 mg/L was 37.50% and 4.17%, respectively, and that of 〉 20 mg/L was 45.83% and 79.17%, respectively （χ2 = 9.56, P = 0.03）. The hypoalbuminemia severity positively correlated with vancomycin concentration in non-CRRT group. Conclusions Vaneomycin concentration is generally higher in these critically ill elderly patients, in which hypoalbuminemia can prolong half-life of vancomycin. CRRT can effectively eliminate vancomyein, thus the TDM of van- comycin is very important to establish an effective and safe treatment protocol.