万古霉素不同输注时长对重症感染患者血药浓度、疗效及预后影响的研究

Effect of vancomycin infusion in different time on blood drug concentration, prognosis and therapeutic effect of severe patients in ICU

目的比较万古霉素不同静脉输注时长对重症感染患者的血药浓度、疗效和预后的影响,并寻找血药浓度影响因素。方法对2015年7月至2018年1月在蚌埠医学院第一附属医院重症监护病房(ICU)使用万古霉素的61例重症感染患者,随机分为Nh静脉滴注(未规定输注时间)组和1 h、3 h静脉泵入组,了解万古霉素习惯性输注时间及血药浓度,并分析比较1 h、3 h静脉泵入组的万古霉素谷浓度、疗效和预后的差异,并使用倾向性匹配筛选验证。最后将所有患者纳入线性回归,分析影响谷浓度的因素。结果万古霉素Nh组的血药浓度为(8.74±6.36)μg/mL。1 h比3 h输注万古霉素谷浓度高[(17.84±14.26)μg/mL,(11.18±7.26)μg/mL]。疗效中1 h组体温较3 h组下降明显,但两组预后差异无统计学意义。回归分析显示年龄、万古霉素使用之前肌酐和尿素氮、谷浓度尿素氮、机械通气时间、万古霉素使用时间是万古霉素谷浓度的影响因素。结论 1 h比3 h内静脉输注万古霉素血药浓度更高,能够达到指南推荐目标谷浓度区间,缩短了治疗时间,并且在控制患者体温方面也有优势,故1 h输注万古霉素是较为合适的选择。年龄、基础肌酐和尿素氮、机械通气时间、万古霉素使用时间是血药浓度的影响因素。

Objective To compare the effects of different intravenous infusion time on the blood drug concentration, efficacy and prognosis of vancomycin in severe patients, and to find out the influencing factors of blood drug concentration. Methods From July 2015 to January 2018, 61 patients with severe infection were treated with vancomycin in the ICU of the First Affiliated Hospital of Bengbu Medical College, and they were randomly divided into two groups: Nh intravenous drip group(no specified time length of infusion)and 1 h, 3 h intravenous pump group. Learn about the time of vancomycin habitual infusion and the concentration of vancomycin in blood, analyze the difference of vancomycin valley concentration, curative effect and prognosis between the two groups, and use propensity matching to filter the verification results.Finally, all patients were included in linear regression to explore the clinical factors associated with valley of vancomycin. Results The concentration of vancomycin valley was(8.74±6.36)μg/mL in Nh group. The concentration of vancomycin valley in 1 h was higher than that in 3 h[(17.84±14.26)μg/mL,(11.18±7.26)μg/mL]. In the therapeutic effect, the body temperature of 1 h group was significantly lower than that of 3 h group, but there was no difference in the prognosis between the two groups.Regression analysis showed that age, creatinine and urea nitrogen before vancomycin use, valley concentration urea nitrogen,mechanical ventilation time and vancomycin use time were correlated with vancomycin valley concentration. Conclusion Vancomycin intravenous infusion in 1 hour is higher than that in 3 hours. It can reach the target trough concentration range recommended by the guidelines and shorten the treatment time;it also has advantages in controlling the temperature of patients. Therefore,vancomycin intravenous infusion in 1 hour is a more suitable choice. Age, basic creatinine and urea nitrogen are still important factors affecting blood drug concentration. Mechanical ventilation, vancomycin use time and vancomycin blood drug concentration are also interrelated factors.