万古霉素2种不同静脉给药方案的疗效及肾毒性的分析

Efficacy and nephrotoxicity of Vancomycin administrated by two different intravenous regimens

目的评价万古霉素用于治疗重症监护室患者时2种不同给药方法的疗效及安全性。方法选择徐州医科大学附属医院重症医学科2014年1月-2016年3月接受万古霉素治疗的患者,共分为两组:0.5 g、8 h/次组30例(A组),治疗时间3~14 d;1.0 g、12 h/次组30例(B组),治疗时间3~18 d。收集各组患者的年龄、性别、血清肌酐(Scr)浓度、白细胞计数、中性粒细胞百分比、血清中万古霉素浓度、万古霉素治疗持续时间等数据。对两组患者的疗效及安全性进行比较,并且评价肾毒性的相关因素。结果 A组谷浓度达标率(10~20μg/ml)达36.7%,B组达16.7%,差异无统计学意义(P=0.080)。A组临床有效率为73.3%,B组为66.7%,两组比较差异无统计学意义(P=0.573)。A组峰值浓度达标率(25~40μg/ml)达36.7%,B组达56.7%,差异无统计学意义(P=0.121)。但是B组的峰值浓度高于A组的峰值浓度[(23.69±10.20)vs(32.29±10.25),P=0.002]。入组的60例患者中共有11例出现肾毒性(A组1例,B组10例),差异有统计学意义(P=0.003)。结论万古霉素的2种静脉用药方法用于治疗重症监护室敏感菌群感染患者时达到的临床疗效差异无统计学意义。B组所达到的峰值浓度高于A组,且肾毒性的发生率也增高,临床上应密切监测患者血药浓度变化,警惕肾毒性的发生。

Objective To evaluate the clinical-efficacy and safety of Vancomycin in two administration methods for treating patients in intensive care unit. Methods Sixty patients treated with Vancomycin in the Intensive Care Unit of the Hospital Affiliated to Xuzhou Medical University from January 2014 to March 2016 were enrolled, and randomly divided into two groups, each group had 30 patients. The patients in group A were administrated 0,5 g Vaneomycin every 8 h for 3-14 d, while those in group B received 1.0 g Vancomycin every 12 h for 3-18 d. Patient＇s age, sex, serum creatinine （Ser）, leucocyte count, neutropbil percentage, serum Vancomycin concentrations and course of treatment were recorded. The clinical efficacy and safety were compared between the two groups and the factors related to renal toxicity were evaluated. Results The compliance rate of minimal concentration （10-20 μg/ml） reached 36.7% in the group A while 16.7% in the group B （P = 0.080）. The clinical effective rate was 73.3% in the group A, and 66.7% in the group B （P = 0.573）. The compliance rate of peak concentration （25-40 μg/ml） reached 36.7% in Ihe group A while 56.7% in the group B （P = 0.121）, The peak concentration of the group B was significantly higher lhan that of the group A [（23.69 ± 10.20） vs （32.29 ± 10.25）, P = 0.002]. Acute renal dysfimction was reported in 1 patient （3.3%） of the group A and 10 patients （33.3%） of the group B （P = 0.003）. Conclusions There is no signifieant difference in the clinical efficacy between lhe two intravenous administration ways of Vaneomyein. The peak concentration of the group B （1.0 g, ql2h） is significantly higher than that of the group A （0.5 g, qgh）, and the ineidenee of renal toxicity is significantly higher than that of the group A. Doetm,＇s should closely monitor tim change of serum drug concentration and be alert lu the occurrence of renal toxicity.