不同剂量万古霉素治疗老年重症肺炎患者的临床疗效及对肾功能的影响分析

Clinical efficacy of different doses of vancomycin in the treatment of elderly patients with severe pneumonia and its effect analysis on renal function

目的观察不同剂量万古霉素治疗老年重症肺炎患者的疗效及对肾功能的影响。方法选择2016年11月至2019年1月本院收治的老年重症肺炎患者132例为研究对象,采用随机数字法分为三组(A组、B组、C组),每组44例。在给予重症肺炎患者基础治疗的前提下,使用不同剂量万古霉素分别对三组患者进行静脉滴注治疗,疗程均为7 d。比较三组患者的临床疗效;比较三组患者万古霉素谷浓度;比较三组患者治疗前后的血肌酐(Scr)、内生肌酐清除率(CCR)、血尿素氮(BUN)、胱抑素C(Cys-C)水平。结果治疗7 d,B组患者的治疗总有效率(90.9%)显著高于A组(50.0%)和C组(54.5%),差异有统计学意义(P<0.05)。万古霉素谷浓度在有效浓度范围的患者比例B组(54.5%)最高,显著高于C组(36.4%)和A组(18.2%),差异有统计学意义(P<0.05)。治疗后,B组患者的Cys-C水平显著升高;C组患者的CCR水平显著降低,BUN、Cys-C水平显著升高,Cys-C水平显著高于A组和B组,差异有统计学意义(P<0.05)。结论使用中等剂量(0.5g/12h)万古霉素治疗老年重症肺炎患者能取得最佳的临床治疗效果,且对患者肾功能的损伤最小。

Objective To observe the efficacy of different doses of vancomycin in elderly patients with severe pneumonia and its effect on renal function.Methods A total of 132 elderly patients with severe pneumonia admitted to our hospital from November 2016 to January 2019 were selected as the research subjects and divided into groups A,B and C according to the random number method,with 44 patients in each group.On the premise of giving basic treatment to patients with severe pneumonia,patients in the three groups were infused different doses vancomycin intravenously,with seven-day treatment courses.The clinical efficacy,vancomycin trough concentration,pre-and post-treatment serum creatinine(Scr),endogenous creatinine clearance(CCR),blood urea nitrogen(BUN),Cystatin C(Cys-C)levels of the three groups were compared.Results After 7 days of treatment,the total effective rate(90.9%)in group B was significantly higher than that in group A(50.0%)and group C(54.5%),and the difference was statistically significant(P<0.05).Patients in group B obtained the highest vancomycin trough concentration in the proportion within the effective concentration range(54.5%),which was significantly higher than that in group C(36.4%)and group A(18.2%),with statistically significant difference(P<0.05).After treatment,the level of Cys-C in group B significantly increased,whereas group C yielded significantly decreased CCR level,and significantly increased BUN and Cys-C levels.The level of Cys-C in group C was significantly higher than that in groups A and B,with statistically significant differences(P<0.05).Conclusion Using medium-dose(0.5g/12h)vancomycin in the treatment of elderly patients with severe pneumonia can achieve the best clinical therapeutic effect,and the damage of renal function is minimal.