某院肾功能正常患者常规应用万古霉素后谷浓度达标情况调查

Investigation on Standard of Vancomycin Trough Concentration for Patients with Normal Renal Function

目的调查ICU肾功能正常的患者,经验性应用推荐剂量万古霉素后,是否能够达到理想的治疗药物谷浓度,并初步探讨其影响因素。方法采用回顾性研究方法,从本院ICU 2014-01~2015-06期间进行过万古霉素血药谷浓度测定的病例中,抽取肾功能正常,用药剂量为万古霉素说明书推荐剂量的病例,将血药浓度测定结果与《万古霉素临床应用中国专家共识》中理想有效谷浓度进行比较,并采用统计学方法考察年龄、性别等因素对谷浓度的影响。结果抽取的45份病历中,仅有11.1%达到了理想的有效血药谷浓度15~20 mg/L,75.5%的患者低于该理想浓度,13.3%的患者超过该理想浓度。男性患者比女性患者的谷浓度有可能更容易偏低（P〈0.05）,年龄可能不是肾功能正常患者万古霉素谷浓度的影响因素（P〉0.05）。结论ICU肾功能正常的患者,采用万古霉素说明书推荐给药剂量1 g Q12 h,不足以达到理想的有效谷浓度。

OBJECTIVE To investigate whether the serum concentration could reach the ideal target trough concentration for the patients with normal renal function who were from intensive care unit（ ICU） administrated with normal dosage of vancomycin and preliminarily discuss on the influential factors. METHODS A retrospective analysis was carried out on the cases of ICU from January2014 to June 2015 with the trough concentration of vancomycin tested. The results of TDM from the selected patients with normal renal function and normal dosage were compared with the ideal target trough concentration in Vancomycin Clinical Application of Chinese Expert Consensus. The effects of factors including age and gender on trough concentration were also investigated. RESULTS Only 11.1% of the all selected 45 cases reached the ideal target trough concentration 15-20 mg / L. 75. 5% of the cases was lower than the target concentration while 13.3% was higher than that value. CONCLUSION The normal dosage of vancomycin（ 1 g Q12 h） is insufficient to reach the ideal target trough concentration for the patients from ICU.