基于《中国万古霉素治疗药物监测指南》对我院万古霉素药物治疗监测现状评价研究

Evaluation on Status of Therapeutic Drug Monitoring of Vancomycinin in Our Hospital Based on Thera peutic Drug Monitoring of Vancomycin of China

目的基于2016年《中国万古霉素治疗药物监测指南》评价我院万古霉素血药浓度监测的现状,为临床合理有效的使用万古霉素提供依据。方法根据2016年7月《中国万古霉素治疗药物监测指南》的推荐标准,将我院2016年7月至2016年12月出院的患者中所有使用万古霉素的住院病例进行回顾性调查,分析万古霉素血药浓度监测结果和抽血时间的关系。分析未进行万古霉素监测患者体重指数、肾功能状态和病情危重程度APACHE II评分与急性肾损害的风险关系。结果使用万古霉素的病例为408例,其中进行血药浓度监测的有107例,监测率是26.2%,共监测197例次。其中76(38.58%)例次的抽血时间在给药后48~72 h。未进行血药浓度监测的病例为301例,其中肥胖患者51例(16.94%),肾功能不全病例36例(11.96%),APACHE II评分大于20的患者有86例(28.57%),而这些患者都应监测血药浓度。结论我院万古霉素血药浓度监测情况与指南推荐存在差距,尤其是肥胖、肾功能不全和重症患者应该加强监测。

Objective To evaluate the status of therapeutic drug monitoring of vancomycin in our hospital based on Therapeutic Drug Monitoring of Vancomycin of China, so as to provide the basis for clinical rational and effective use of vancomycin. Methods According to the Therapeutic Drug Monitoring of Vancomycin recommendation, all discharged cases data of the use of vancomycin in the hospital from July 2016 to December 2016 were retrospectively investigated. We analyzed the relationship between blood drug concentration of vancomycin and timing of collecting serum, and the relationship between the risk of acute kidney injury with the body mass index, renal function state and a critical condition in the group without blood drug concentration monitoring of vancomycin. Results There were 408 cases that used vancomycin. 107 cases were monitored blood drug concentration, the monitoring percentage is 26.2%. All these patients were monitored 197 times,of which 76 （38.58%） times of blood sampling in 48~72 h after dosing. 301 cases who used vancomycin were not monitored blood drug concentration, among which 51 cases （16.94%） of obese patients, 36 cases（11.96%） of renal insufficiencypatients, 86 cases （28.57%） of APACHE II score more than 20. But these patients should be monitored blood drug concentration of vancomycin. Conclusion The condition of vancomycin monitoring of blood drug concentration has a gap between our hospitaland guidelines recommendation, especially for obesity, renal insufficiency, and severe illness, we should strengthen the monitoring, to ensure the effectiveness of vancomycin use and to reduce the occurrence of kidney toxicity.