万古霉素抗感染治疗患者血药浓度的监测与分析

Monitoring and Analysis on Blood Concentrations of Vancomycin in Patients with Anti-infective Therapy

目的:分析万古霉素血药浓度的监测与临床用药情况。方法:采用均相酶放大免疫法监测万古霉素的谷浓度,分析医院近1年106例次患者采用万古霉素治疗后的血药浓度的监测结果以及病原菌的分布及其耐药性。结果:检测的106例次万古霉素抗感染治疗患者涉及16个科室,病原学的检测送检率达91.51%;万古霉素对大部分革兰阳性菌较敏感,其中报出1株屎肠球菌对万古霉素耐药;54例次患者首次监测万古霉素谷浓度处于10～20μg/mL范围内,22例次重症感染患者调整万古霉素剂量后行二次血药浓度监测,17例次患者谷浓度处于10～20μg/mL范围内,二次血药浓度监测与首次监测相比,其结果明显好转(P<0.05);其中万古霉素抗感染治疗失败患者27例,7例患者发生了万古霉素相关的不良反应,停药后好转。结论:万古霉素血药浓度的监测对临床安全合理用药有重要意义,但是万古霉素的个体差异较大,影响因素较多,临床医生和药师仍需加强关注。

Obiective: To analyze the monitoring results of Vancomycin blood concentration and its clinical medication.Methods: The valley concentration of vancomycin was monitored by homogeneous enzyme amplification immunoassay. The blood drug concentration monitoring results of 106 patients treated with vancomycin in the hospital in the past year, as well as the distribution of pathogenic bacteria and their drug resistance were analyzed. Results: A total of 106 patients were tested for vancomycin anti-infective therapy involving 16 departments. The detection rate of etiology was 91.51%. Vancomycin was sensitive to most gram-positive bacteria, and one strain of enterococcus faecalis was reported to be resistant to vancomycin. The vancomycin concentration was between the range of 10 and 20 g/mL for the first time in 54 patients, the vancomycin concentration was within the range of 10~20 g/mL for the second time in 22 patients with severe infection, and the valley concentration was between the range of 10 and 20 g/mL for 17 patients. Compared with that of the first time, the results of the second blood drug concentration monitoring were significantly improved(P<0.05). Among them, 27 patients failed to receive vancomycin anti-infection treatment, and 7 patients developed vancomycin-related adverse drug reactions, which were improved after withdrawal. Conclusion: The monitoring of vancomycin blood concentration is of great significance for clinical safety and rational drug use. However, the individual differences of vancomycin are large and there are many influencing factors, so clinicians and pharmacists still need to pay more attention to vancomycin.