检测万古霉素血药浓度对耐药革兰阳性菌感染者合理控制用药剂量的影响研究

Study on the Effect of Detecting Vancomycin Blood Concentration on the Rational Control Dosage of Drug-resistant Gram-positive Bacteria

目的探讨万古霉素血药浓度检测对耐药革兰阳性菌感染患者用药剂量合理控制的影响。方法选取该院2016年1月—2018年1月收治的100例耐药革兰阳性菌感染患者,患者接受万古霉素治疗,静脉滴注,分析万古霉素血药谷浓度检测分布区间和构成比,监测后万古霉素血药谷浓度剂量调整,对比不同血药谷浓度万古霉素临床疗效和不良反应发生率。结果该组有33例(33.00%)患者万古霉素血药谷浓度分布区间在10~20μg/mL。根据万古霉素谷血药谷浓度检测结果,该研究为39例患者调整了后续给药剂量,其中降低剂量24例,增加剂量15例。选取27例指征性治疗患者,对比高浓度组(≥10μg/mL)与低浓度组(<10μg/mL)的临床疗效,结果差异无统计学意义(P>0.05)。27例指征性治疗患者共出现4例不良反应,多集中于血药谷浓度检测分布区间>20μg/mL者。结论万古霉素治疗效果的影响因素较多,血药浓度越高就越可能出现不良反应,进一步说明血药浓度检测不仅能促进用药剂量合理调整,还能降低不良反应。

Objective To investigate the effect of vancomycin blood concentration on the rational control of drug-resistant Gram-positive bacteria infection patients.Methods 100 patients with drug-resistant Gram-positive bacteria admitted to the hospital(January 2016 to January 2018)were enrolled.Patients were treated with vancomycin and intravenously instilled to analyze the distribution of vancomycin blood concentration.Interval and composition ratio,post-monitoring dose adjustment of vancomycin blood concentration,comparing the clinical efficacy and incidence of adverse reactions of different blood drug concentrations of vancomycin.Results The distribution of vancomycin blood concentration in 33 patients(33.00%)in this group ranged from 10 to 20μg/mL.According to the results of vancomycin trough blood concentration test,this study adjusted the follow-up dose for 39 patients,including 24 patients with reduced dose and 15 patients with increased dose.27 patients with indication therapy were compared with the high-concentration group(≥10μg/mL)and the low-concentration group(<10μg/mL).The difference was statistically significant(P>0.05).A total of 4 adverse reactions occurred in 27 patients with indication therapy,mostly concentrated in the distribution range of blood drug concentration detection>20μg/mL.Conclusion There are many factors influencing the therapeutic effect of vancomycin.The higher the blood concentration,the more likely the adverse reactions will occur.It further indicates that the blood drug concentration test can not only promote the reasonable adjustment of the dosage,but also reduce the adverse reactions.