万古霉素血药浓度监测256例次分析

Clinical application and serum concentration monitoring of vancomycin: analysis of 256 cases

目的分析万古霉素血药浓度监测和临床应用情况,为临床合理用药提供参考。方法回顾性调查安徽医科大学第一附属医院2016年7月至2017年6月进行万古霉素血药浓度监测的病人信息,统计分析血药浓度、感染部位、肾功能等数据。结果纳入141例病人、256例次浓度监测,总血药浓度(19.22±11.33)μg/mL,首次浓度(18.40±11.88)μg/mL,浓度在10~20μg/mL的构成比分别为32.81%、30.05%,两组差异无统计学意义。e GFR 75~110 mL·min^-1·1.73 m^-2组病人万古霉素浓度达标率45.20%。58.73%的肾功能严重受损病人血药浓度高于20μg/mL(e GFR<40 mL·min^-1·1.73 m^-2),然而e GFR≥110mL·min^-1·1.73 m^-2的病人中,45.24%血药浓度低于10μg/mL。用药前后,5例病人肾损害可能与药物相关。结论万古霉素首次与总血药浓度达标率均较低,尤其是肾功能不全或亢进的病人人群,监测结果未能在临床应用中充分发挥作用。临床应用加强血药浓度监测,同时综合病人临床情况,选择适宜的给药方案,实现个体化治疗,提高药物的安全、有效性。

Objective To investigate the clinical utilization and serum concentration monitoring of Vancomycin,in order to provide a reference for rational clinical use of the medicine.Methods A retrospective analysis was carried out,including information of the patients who received the monitoring of Vancomycin concentration in blood in the First Affiliated Hospital of Anhui Medical University from July 2016 to June 2017.Results A total of 256 cases of Vancomycin serum concentration were detected.The average concentration of Vancomycin was(19.22±11.33)μg/mL,and 32.81%of these case were in the effective range(10~20μg/mL).The first monitoring of average concentration was(18.40±11.88)μg/mL,and 30.05%of these case were in the effective range.There was no significant difference between the two groups.A total of 45.20%of the patients with estimated glomerular filtration rate(e GFR)75~110 mL/(min·1.73 m^2)obtained the effective concentration of Vancomycin in blood.However,more than 50%of the patients,e GFR below 40 mL/(min·1.73 m^2),whose serum concentration of Vancomycin were over 20μg/mL.On the contrary,patients with high e GFR[≥110 mL/(min·1.73 m^2)]showed lower Vancomycin concentration,and the percent came up to 45.24%.5 patients suffered from renal impairement during therapy,which correlated with the drug toxicity.Conclusion In our hospital,low rate of Vancomycin concentration reaches effective range,especially in the patients with incompetence or sthenia renal function.That means Vancomycin concentration monitoring failed to play a full role in clinical application.It is vital to enhance Vancomycin concentration monitoring in blood during the application in clinic.Meanwhile,patients’physiological and pathological conditions should be consideredwhen choosing appropriate dosage regimen for individuals.Finally,the safety and effectiveness during therapies should be improved.