万古霉素血药浓度对老年患者肾功能的影响

Effects of serum concentration of Vancomycin on renal function in elderly patients

目的调查老年人万古霉素血药浓度、肾功能与给药剂量之间的关系,为老年人合理应用万古霉素提供参考。方法采用回顾性分析法,选取2015年10月~2016年7月首都医科大学附属北京友谊医院(以下简称"我院")静脉应用万古霉素老年住院患者,对其临床资料、肾功能、给药剂量、血清谷浓度监测结果进行分析。结果有效病例72份,共监测147例次万古霉素谷浓度,平均谷浓度(19.35±8.73)mg/L,其中低于10 mg/L占12.93%,10~20 mg/L占44.90%,高于20 mg/L占42.17%。不同年龄段老年人万古霉素谷浓度水平比较差异无统计学意义(P>0.05)。在日剂量为1.0 g时,超过半数的老年患者万古霉素谷浓度可以维持在有效治疗浓度10~20 mg/L范围内。慢性肾功能不全3~4期的老年患者平均血清谷浓度大于20 mg/L。结论我院多数使用万古霉素的老年人可达到有效治疗浓度,日剂量1.0 g为万古霉素相对安全的给药剂量,慢性肾功能不全4期的老年患者应酌情减少日剂量。

Objective To investigate the relationship between serum concentrations of Vancomycin, renal function and administration dosage, so as to provide reference for the rational use of Vaneomycin in the elderly patients. Methods By retrospective analysis method, elderly inpatients with intravenous application of Vancomycin in Beijing Friendship Hospital, Capital Medical University （＂our hospital＂ for short） from October 2015 to July 2016 were selected to analyze the clinical data, renal function, administration dosage and serum concentration. Results Seventy-two patients were included in the study. 147 cases of Vancomycin trough concentration were monitored. The average trough concentration was （19.35± 8.73） mg/L, the rate of the trough concentration below 10 mg/L was 12.93%, the rate of the trough concentration of 10- 20 mg/L was 44.90%, the rate of the trough concentration above 20 mg/L was 42.17%. There was no significant differ- ence in Vancomyein trough concentration in different age groups （P 〉 0.05）. At a daily dose of 1.0 g, more than half of the elderly with Vancomycin trough concentrations were maintained an effective concentration range of 10-20 mg/L. The mean trough serum concentration of the elderly patients with chronic kidney disease 3-4 stage was higher than 20 mg/L. Conclusion In our hospital, the majority of the elderly can achieve the effective Vancomycin concentration. 1.0 g/d is a safe dosage of Vancomycin, and the elderly patients with chronic kidney disease 4 stage should reduce the daily dose.