老年患者万古霉素血药浓度分析及给药方案探讨

Analysis of blood drug concentration of vancomycin in elderly patients and discussion on dosage regimen

目的:对某院老年患者万古霉素血药浓度监测结果及对肾功能影响进行分析,并探讨给药方案的适宜性。方法:将符合入选标准的120例老年患者,按日剂量把给药方案分为4组,对万古霉素血清谷浓度以及治疗前后相关肾功能指标进行统计分析。结果:120例老年患者中,血药谷浓度监测结果在参考范围10~20 mg·L^(-1)的占41.67%,高于参考范围的占43.33%;轻度肾功能不全老年患者万古霉素给药方案为1g qd/0.5g q12h的仅占47.92%,给药方案为0.5g q8h或1g q12h的有近30%老年患者存在肾功能不全;万古霉素给药方案为1g q12h组,老年患者治疗前后内生肌酐清除率有统计学差异(P<0.05)。结论:老年患者使用万古霉素个体差异大,谨慎使用1g q12h的给药方案,给药方案需在血药谷浓度监测下进行调整。

OBJECTIVE To analyze the blood drug concentration results of vancomycin and effect on renal functions in elderly patients in our hospital,and discuss the suitability of the dosage regimen.METHODS According to the inclusion criteria,120 elderly patients were divided into four groups on basis of daily dose.The blood drug trough concentration of vancomycin and the related renal function indexes before and after treatment were statistically analyzed.RESULTS Among 120 cases of elderly patients,41.67% monitoring results of blood trough concentration were in the reference range of 10-20 mg·L^（-1）,43.33% were higher than the normal reference range.Mild renal insufficiency was observed in only 47.92% elderly patients treated with vancomycin at 1 g qd/0.5 g q12 h,and nearly 30% elderly patients at 0.5 g q8 hor 1 g q12 h.There was significant difference in endogenous creatinine clearance rate（P0.05）before and after treatment in 1 g q12 hgroup.CONCLUSION Individual difference is present in the use of vancomycin in elderly patients,so it should be more careful to use 1 g q12 hregimen,and dosage regimen should be adjusted during blood trough concentration monitoring.