危重症患者万古霉素血药浓度监测与临床结局的相关性研究

Relationship between vancomycin's blood concentration monitoring and clinical outcomes in critically ill patients

目的比较使用万古霉素期间进行血药浓度监测和未进行血药浓度监测的危重症患者临床结局的差异,探讨危重症患者进行万古霉素血药浓度监测的必要性。方法选取我院224例耐甲氧西林金黄色葡萄球菌(MRSA)感染并使用万古霉素治疗的危重症患者,其中治疗药物监测组81例,非治疗药物监测组143例,对TDM组和非TDM组患者的肌酐、C反应蛋白水平、治疗时间、累计剂量、峰浓度和谷浓度结果进行统计分析。结果 TDM组与非TDM组万古霉素平均治疗天数、治疗前后的CRP水平比较差异无统计学意义(P> 0. 05);TDM组万古霉素平均累计使用总剂量(10. 2 g)明显小于非TDM组(14. 3 g)(P <0. 05); TDM组患者肌酐水平增加率(9. 9%)明显小于非TDM组(16. 1%)(P <0. 05); TDM组万古霉素血清峰浓度、谷浓度与治疗天数的对数均呈显著性相关(P <0. 01)。结论血药浓度监测可以提高危重症患者万古霉素的临床疗效并降低肾毒性的发生率,推荐危重症患者万古霉素个体化用药过程中积极开展血药浓度监测。

Objective To investigate the correlation between the blood concentration monitoring and the clini-cal outcome,and to explore the necessity of monitoring the blood concentration of vancomycin in critically ill patients. Methods Totally 224 critically ill patients with methicillin-resistant Staphylococcus aureus （ MRSA） infection admit-ted to our hospital were selected,81 cases in therapeutic drug monitoring group （ TDM group） and 143 cases in non-therapeutic drug monitoring group （ non-TDM group） , the level of creatinine, C-reactive protein, duration of therapy, cumulative dose, peak concentration and trough concentration results in TDM group and non-TDM group were statisti-cally analyzed. Results The duration of vancomycin treatment and the level of CRP before and after treatment showed no significant difference in TDM group and non-TDM group （ P 〉 0.05） ; the average cumulative total dose of vanco-mycin （10. 2 g） in TDM group was significantly lower than that in non-TDM group （ 14. 3 g） （ P 〈 0.05 ） ; the in-crease rate of creatinine level in TDM group （9. 9% ） was lover than that in non-TDM group （16. 1% ） （P 〈0.05）; the logarithm of serum vancomycin concentration was correlated with the days of treatment significantly （P 〈0. 01）. Conclusion Blood concentration monitoring can improve the clinical efficacy of vancomycin in critically ill patients and reduce the incidence of nephrotoxicity. It is recommended to monitor blood concentration in the process of individu-alized medication for critically ill patients.