重症感染患者负荷剂量替考拉宁的血药浓度监测

Monitoring of scrum concentration of load dose teicoplanin in patients with severe infection

目的:通过监测重症感染患者负荷剂量替考拉宁血药谷浓度,分析药物谷浓度分布情况、达标率、影响因素及临床疗效和安全性,为合理用药提供参考。方法:选取2017年12月至2018年4月解放军总医院重症医学科收治的疑似或确诊多重耐药革兰阳性菌(G+)感染患者共40例,根据负荷天数不同分为A组(3d,n=22)和B组(4 d,n=18),给予替考拉宁每12 h400 mg,之后以400 mg·d-1维持,分别于首次维持剂量给药前30 min测定替考拉宁血药谷浓度(Cmin);同时测定用药过程中患者肝、肾功能相关指标,记录其不良反应。结果:Cmin>10 mg·L-1总达标率为65%。A、B2组达标率分别为50.0%和83.3%,差异有统计学意义(P<0.05)。除肌酐清除率(Ccr)外,其余因素对Cmin无影响。临床好转率95%,用药过程中未出现急性肝、肾损伤。结论:重症感染患者替考拉宁血药浓度随负荷剂量天数增加,血药谷浓度达标率及临床好转率升高,临床用药安全性好。

Objective:By monitoring the blood drug concentration of teicoplanin in the patients with severe cases,the distribution of drug concentration,the rate of reaching the standard,influencing factors,clinical efficacy and safety were analyzed,so as to provide a reference for rational drug use.Methods:A total of 40 patients with suspected or confirmed multi-drug-resistant Gram-positive(G+)infections from a hospital in the department of critical care medicine from December 2017 to April 2018 were enrolled in.Each patient was administered with teicoplanin 400 mg every12 hours.According to different loading days,the patients were divided into group A(load 3 days,n=22)and group B(load 4 days,n=18),and then 400 mg·d-1 was maintained.The concentration of teicoplanin plasma was measured 30 min before the first maintenance dose(Cmin);simultaneously the liver and kidney function related indicators and other adverse reactions of the patients were analyzed.Results:The total compliance rate of Cmin>10 mg·L-1 was 65%.The compliance rates of A and B groups were 50.0%and 83.3%,respectively,with statistical difference(P<0.05).Multiple linear regression analysis showed that all the factors had no statistically significant effect on the plasma concentration except the Ccr.The clinical improvement rate was 95%,and no acute liver or kidney injury occurred during the medication.Conclusion:The scrum concentration of teicoplanin in severe infection patients increased with the increase of the load dose days.The standard rate of blood drug concentration and the clinical improvement rate were increased The safety of clinical medication was good.