老年患者万古霉素血药谷浓度110例次分析

Analysis of trough vancomycin concentrations on 110 elderly cases

目的分析老年患者万古霉素谷浓度与肾功能及药物剂量之间的关系,为老年患者合理使用万古霉素提供参考。方法选取2015年11月至2016年4月在首都医科大学附属北京友谊医院住院并进行万古霉素血药浓度监测的老年患者,回顾性分析其临床资料、肾功能、万古霉素剂量与谷浓度监测结果。结果共纳入老年患者38例,共计110例次万古霉素谷浓度检测结果,谷浓度均值（20.41±8.85）mg/L,其中低于10 mg/L者10.0%,10-20 mg/L者40.9%,高于20 mg/L者49.1%。不同性别、不同年龄段老年患者万古霉素谷浓度水平无统计学差异（P〉0.05）。54.9%老年患者接受万古霉素初始剂量为1.0 g/d,对应谷浓度为（14.33±5.32）mg/L,接受1.5 g/d和2.0 g/d初始剂量的谷浓度相近,分别为（22.83±8.58）和（20.76±9.74）mg/L。肾小球滤过率（GFR）≥60 ml/min的老年患者万古霉素谷浓度为（17.20-20.92 mg/L）,GFR 30-59 ml/min的患者谷浓度升至（26.87±11.02）mg/L,GFR 15-29 ml/min者用药量减少,但谷浓度仍超标（24.58±8.69 mg/L）。结论该院多数应用万古霉素治疗的老年患者达到有效治疗浓度,万古霉素1.0 g/d是比较稳妥的初始给药剂量,GFR〈60 mL/min的老年患者万古霉素剂量应酌减。

Objective To guide rational use of vancomycin in elderly patients by analyzing trough vancomycin concentrations,renal function and vancomycin dosing. Methods A retrospective analysis was carried out in elderly inpatients with vancomycin therapeutic drug monitoring（ TDM） in Beijing Friendship Hospital,Capital Medical University from November 2015 to April 2016. The patients＇ clinical information,renal function,vancomycin dosing and trough vancomycin concentrations were analyzed retrospectively. Results Thirty- eight elderly inpatients at the average age of（ 78. 3 ± 10. 2） years old were enrolled in this study. A total of 110 trough vancomycin concentrations were collected and the average concentration was（ 20. 41 ± 8. 85） mg / L. The ratios of trough concentrations beneath 10 mg / L,10 - 20 mg / L and over 20 mg / L were 10. 0%,40. 9% and 49. 1% respectively. There were no significant differences between male and female or among different age groups of the elderly patients（ P〉0. 05）. More than half（ 54. 9%） of cases who received vancomycin 1. 0 g per day reached trough concentration of（ 14. 33 ± 5. 32）mg / L. Trough concentrations of those received vancomycin 1. 5 g per day and 2. 0g per day were（ 22. 83 ± 8. 58） and（ 20. 76 ± 9. 74） mg / L respectively. Patients with glomerular filtration rate（ GFR） over 60 m / min got trough concentration of（ 17. 20 - 20. 92） mg / L,while those with GFR 30 - 59 ml / min and 15 - 29 ml / min got higher trough concentrations as（ 26. 87 ± 11. 02） mg / L and（ 24. 58 ± 8. 69 mg / L） respectively,although some of them had received a decreased vancomycin dosing. Conclusion Most of the elderly inpatients receiving vancomycin therapy in our hospital reach the recommended concentrations. Vancomycin 1. 0 g per day is a reliable empirical dosing for the elderly. The elderly patients with GFR 〈60 mL·min- 1should be given reduced vancomycin dosing.