渗透性治疗对神经危重症患者万古霉素血药浓度的影响

Impact of Osmotic Treatment on Plasma Concentration of Vancomycin in Critically Neurologic Patients

目的:考察神经危重症患者的渗透性治疗对其万古霉素血药浓度的影响,为临床治疗提供参考。方法:选取2012年1月至2016年3月本院重症医学科使用万古霉素抗感染治疗的神经危重症患者130例,根据万古霉素是否联用渗透性治疗以及渗透性治疗的种类,分为未联用组(21例)、高渗盐水组(18例)、甘露醇组(29例)、甘油果糖组(20例)、利尿剂组(22例)和多药联用组(20例),回顾并统计患者基本临床信息、渗透性治疗及万古霉素的给药方案和血药浓度。结果:神经危重症患者血药浓度达推荐范围的比例均较低,与未联用组的平均血药浓度(14.3±4.88)mg/L相比,甘露醇组、甘油果糖组和多药联用组的血药浓度分别为:(10.6±5.83)mg/L,(8.3±4.96)mg/L,(8.01±5.84)mg/L,均显著降低(P<0.05),而高渗盐水组、利尿剂组的血药浓度分别为(14.8±6.03)mg/L,(12.6±3.47)mg/L,未出现明显变化(P>0.05)。结论:渗透性治疗中仅甘露醇、甘油果糖以及同时使用多种渗透性药物才能显著降低万古霉素血药浓度,神经危重症患者,尤其是采取渗透性治疗的患者需密切监测万古霉素血药浓度,及时调整给药剂量。

Objective ： To investigate the influence of osmotic treatment on plasma concentration of vancomycin in critically neurologic patients, so as to provide a reference for clinical treatment. Methods： A total of 130 critically neurologic patients receiving anti-infectious treatment by vancomycin in the intensive care unit of our hospital from January 2012 to March 2016 were selected. According to the combination of vancomycin with the osmotic treatment and the types of the latter, the patients were divided into uncombined group（21 patients）, hypertonic saline group（18patients）, mannitol group（29 patients）, glycerol fructose group（20 patients）, diuretic group（22 patients） and multiple drug combination group（20 patients）. The clinical characteristics of the patients, the regimen of the osmotic treatment as well as the dose and plasma concentration of vancomycin were retrospectively investigated and statistically analyzed.Results： The percentages of the plasma concentration of vancomycin meeting the standard recommended were low in critically neurologic patients. The plasma vancomycin concentrations in mannitol group, glycerol fructose group and multiple drug combination group were（10.6 ± 5.83） mg/L,（8.3 ± 4.96） mg/L,（8.01 ± 5.84） mg/L and decreased significantly（P〈0.05） compared with those in uncombined group（14.3 ± 4.88） mg/L, while those in hypertonic saline group and diuretic group were（14.8 ± 6.03） mg/L and（12.6 ± 3.47） mg/L respectively and showed no significant change（P〉0.05）. Conclusion： In the osmotic treatment, only mannitol, glycerol fructose and multiple drug combination may decrease the plasma vancomycin concentration significantly. For critically neurologic patients, especially those who receive osmotic treatment, the plasma vancomycin concentration should by monitored carefully and the dosage should be adjusted in time.