不同厂家的万古霉素血药谷质量浓度、安全性和疗效比较

Comparison of blood drug trough concentration,safety and efficacy of vancomycin from different manufacturers

目的通过分析我院使用的2个厂家的万古霉素血药谷质量浓度、肾毒性和疗效,为实现临床个体化给药及合理使用万古霉素提供参考。方法采用回顾性分析法,收集我院使用万古霉素并监测血药谷质量浓度的59例患者病历,根据使用的万古霉素厂家不同随机分为A组(n=30)和B组(n=29),分析2组的血药谷质量浓度、病原学检查、用药后肾功能及疗效。结果 2组使用万古霉素患者的科室分布情况相当,ICU为使用万古霉素的主要病区。2组使用万古霉素与抗菌药联合使用情况相当,2组病原学检出差异无统计学意义。A组和B组2～<20岁、20～<40岁、40～<60岁及≥60岁4个年龄段的血药谷质量浓度监测相当。与A组比较,B组血药谷质量浓度小于10 mg·L^(-1)例数较多(P<0.05),10～20 mg·L^(-1)的例数较少(P<0.05);B组的肾功能异常例数较多,但差异无统计学意义;A组的有效例数较多(P<0.05),无效例数较少(P<0.05)。结论万古霉素的血药谷质量浓度越高,疗效越好,但肾毒性也越高,不同厂家生产的万古霉素质量存在差异。为保证万古霉素使用的安全性、有效性,应加强对患者的肾功能和血药谷质量浓度的监测,及时调整给药方案。

Objective To analyze and compare 2 manufacturers′ vancomycin blood drug trough concentration,nephrotoxicity and efficacy for clinical individualized administration and rational use.Methods A retrospective analysis was performed in which,59 cases patients who used vancomycin in our hospital were collected and divided into group A ( n =30) and group B ( n =29) according to manufacturer.The blood drug trough concentration,etiological examination,renal function and therapeutic effect after treatment were analyzed.Results The department distribution of the 2 groups was comparable.The ICU was the main ward for vancomycin use.The combination of vancomycin and antibacterials in the 2 groups was comparable.4 levels of blood drug trough concentration monitoring (2-<20 years,20-<40 years,40-<60 years,≥60 years) in the 2 groups were comparable.Compared with the group A,the cases of vancomycin′s blood drug trough concentration <10 mg·L^-1 were more ( P <0.05),and 10-20 mg·L^-1 were less ( P <0.05) in the group B.Compared with the group A,there were more cases of renal dysfunction in the group B,but the difference was not statistically significant.Compared with the group A,there were more effective cases ( P <0.05) and less ineffective cases in the group B ( P <0.05).Conclusion The higher the vancomycin blood drug trough concentration,the better the curative effect,but the higher nephrotoxicity.The quality of vancomycin produced by different manufacturers might be different.To increase the safety and effectiveness of vancomycin,it is suggested to strengthen the patient′s renal function and blood drug trough concentration monitoring,timely adjustment of drug delivery program.