2015年某院治疗药物浓度监测结果回顾性分析

Retrospective analysis of monitoring results of therapeutic drug concentration in a hospital in 2015

目的:回顾性分析某院患者血药浓度监测数据,探讨血药浓度监测在临床合理用药的作用。方法:对某院2015年9种治疗药物监测数据进行回顾性分析,包括监测品种的构成情况,测定频率情况,监测比例情况以及各个监测品种的监测结果及科室分布情况。结果:该院监测例数和测定频率最多的是免疫抑制剂环孢霉素A,占我院所有监测品种次数的80.3%,其次是甲氨蝶呤和他克莫司。他克莫司、甲氨蝶呤、环孢素A和地高辛监测比例均达到60%以上。90.1%儿科患者的42 h甲氨蝶呤血药浓度分布在0.1~1μmol·L^(-1)。抗癫痫药物中监测次数最多的是丙戊酸,但多数仅监测一次,说明医师和患者对抗癫痫药物的血药浓度的重视程度不够。万古霉素和地高辛用药人群为老年人,建议将血药浓度调整在正常范围的中下限。结论:血药浓度"正常"的构成比较高,说明该院临床医师已充分意识到治疗药物监测的重要性,此外仍需要医师与临床药师密切配合,根据血药浓度监测结果,调整给药方案,有效提高治疗成功率。

OBJECTIVE To retrospectively analyze blood drug concentration monitoring data,discuss the role of blood drug concentration monitoring in clinical rational drug use.METHODS Nine kinds of therapeutic drug monitoring data of a hospital in 2015 were retrospectively analyzed,including the composition of all monitored species,measurement frequency,the monitoring ratio,monitoring results and distribution of departments for each monitor species.RESULTS Immunosuppressant cyclosporin A had the most monitoring patients and the highest measuring frequency,accounting for 80.3%in the hospital for all monitoring species number,followed by methotrexate and tacrolimus.Tacrolimus,methotrexate,cyclosporine A and digoxin monitoring ratio reached 60% or more.In 90.1% of pediatric patients,methotrexate blood concentration at 42 h was 0.1-1μmol·L-1.Valproate had the most monitoring number of patients among all the antiepileptic drugs,most of which were only monitored once,indicating that physicians and patients with emphasis paid inadequate attention on plasma concentrations of antiepileptic drugs.Vancomycin and digoxin were mainly used for the elderly,it was recommended to adjust their blood concentrations in the lower limit of the normal range.CONCLUSION The blood drug concentration of ＂ normal＂ form is relatively high,indicating that the clinicians in the hospital have been fully aware of the importance of therapeutic drug monitoring.But physicians and clinical pharmacists still need to work closely,according to the results of blood concentration monitoring,adjust the dosing regimen to effectively improve the success rate of treatment.