老年患者应用万古霉素的治疗药物监测与肾毒性评价

Research on the Therapeutic Drug Monitoring and Nephrotoxicity of Vancomycin in Elderly Patients

目的:评价老年患者应用万古霉素的谷浓度和临床疗效、肾毒性的相关性。方法:回顾性分析,选取我院应用万古霉素并监测其血药浓度的69例老年住院患者,按血药谷浓度监测结果划分为L(<10 mg·L^(-1))、M(10～20 mg·L^(-1))、H(>20 mg·L^(-1))3组,分别对其血药浓度、临床疗效评定结果、肾功能指标进行统计分析。结果:L、M、H 3组临床有效率分别为88.24%、76.92%、38.47%,肾损伤发生率分别为0.00%、7.69%、30.77%,差异均有统计学意义(P=0.007、P=0.016)。L和M组疗效和肾功能损伤发生率无显著性差别,两组疗效均显著性高于H组,肾功能损伤发生率显著性低于H组。结论:万古霉素谷浓度高于20 mg·L^(-1)并不能进一步提高临床疗效,反而会引起肾功能损伤。老年患者在治疗过程中需监测万古霉素谷浓度,以减少不良反应的发生。

Objective:To investigate the correlation between the trough concentration of vancomycin and efficacy plus nephrotoxicity.Methods:Sixty-nine senile inpatients treated with vancomycin were enrolled in this study.These inpatients were divided into 3 groups according to the concentrations of vancomycin,namely group L(<10 mg·L^-1),group M(10-20 mg·L^-1)and group H(>20 mg·L^-1).The trough concentrations of vancomycin,the efficacy and renal indexes of these inpatients were monitored and recorded.Results:There were significant differences among the 3 groups in terms of clinical efficacy and kidney injury rates.Furthermore,there was no significant difference between group L and M in the rates of efficacy and kidney injury.The efficacy rates of group L and M were significantly higher than that of group H,while their kidney injury rates were significantly lower than that of group H.Conclusions:The trough concentration of vancomycin above 20 mg·L^-1 might induce nephrotoxicity without improvement of therapeutic efficacy.Therefore the trough concentration of vancomycin in senile patients should be monitored to reduce side-effects.