万古霉素血清药物浓度监测与临床应用评价

An Evaluation of the Relationship Between Therapeutic Drug Monitoring of Vancomycin and Clinical Utility

目的评价我院万古霉素血清谷浓度监测与万古霉素临床治疗有效性和安全性的关联。方法回顾性调查118例入住我院重症监护病房,病原学检测为革兰氏阳性菌且进行万古霉素血清谷浓度监测的患者,分层分析万古霉素血清浓度与疗效和肾毒性间的关联。结果以万古霉素血清药物浓度分组,三组均以老年男性患者居多,有接近一半的患者血药浓度没有达标,未达标患者中有过半数没有进行药物浓度连续监测。随着万古霉素浓度的升高,基础肌酐值逐渐升高,连续监测药物浓度的患者比例也逐渐增高。血清药物浓度与血液指标的好转、临床总有效率间没有统计学关联。随着万古霉素血清药物浓度的升高,肾毒性发生率有所增加,但不具有统计学意义。出现肾毒性的患者血清基础肌酐浓度明显高于无肾毒性患者,差异具有统计学意义。结论规范的药物浓度监测辅助万古霉素安全有效的临床应用,尤其对于肾功能损伤的患者,应重视血清药物浓度监测,以减少肾毒性。

Objective To evaluate the correlation between vancomycin serum trough concentration and its clinical efficacy and safety. Methods A retrospective study was conducted to investigate the relationship between serum concentration of vancomycin and the effect of vancomycin and the renal toxicity of vancomycin in 118 patients who were examined as Gram-positive bacterial infection.Specifically,we measured the serum trough concentration of vancomycin in the department of ICU of our hospital. Results Patients were stratified into three groups according to the concentration of serum trough levels of vancomycin.The majority in the three groups were all elderly male patients.Nearly half of the patients had no standard blood concentration,and half of the patients in the unsatisfied concentration groups did not receive continuous monitoring of drug concentration.With the increase of vancomycin concentration,the creatinine level gradually increased,and the proportion of patients who had continuously monitored the concentration of drugs increased.There was no statistical correlation between serum drug concentration and the improvement of blood index and clinical total effective ratio.With the increase of serum concentration of vancomycin,the incidence of nephrotoxicity increased,but it was not statistically significant.The level of serum creatinine in patients with nephrotoxicity was significantly higher than that in patients without renal toxicity. Conclusion The standardized drug concentration monitoring ensures the safty and effectiveness of the clinical application of vancomycin.Especially for patients with renal impairment,the monitoring of serum drug concentration should be paid more attention to reduce the renal toxicity.