357例次替考拉宁血药浓度监测结果分析

Analysis of 357 cases of teicoplanin plasma concentration

目的:分析我院替考拉宁血药浓度监测结果及用药方案特点,为临床合理用药提供参考。方法:收集2017年12月至2018年12月我院使用并监测替考拉宁血药浓度患者的病例资料,回顾性分析替考拉宁治疗方案及血药浓度的分布情况,探讨血药浓度达标与治疗方案的关系及影响因素。结果:214例患者共监测替考拉宁血药浓度357例次,血药浓度达标(>10μg·mL-1)的比例为43.4%。最常用的给药方案为初始每12 h给药0.4 g,连续3次,其后维持剂量0.4 g qd,占43.5%,该方案在治疗早期(2~6 d)血药浓度达标率为22.0%。每12 h给药0.4 g,连续5次,维持剂量为0.4 g qd的患者,治疗早期血药浓度达标率为35.6%;治疗初期每12 h给药0.4 g至少3 d的患者,治疗早期血药浓度达标率为68.4%,治疗初期增加替考拉宁日剂量可提高血药浓度达标率。血药浓度达标与肌酐清除率和累计剂量/体重相关(P<0.05)。结论:临床中替考拉宁血药浓度达标率低,个体差异大,为保证临床疗效可考虑适当增加替考拉宁的初始给药剂量,监测血药浓度对优化替考拉宁的个体化治疗具有重要的意义。

Objective:To analyze the characteristics of the results of therapeutic drug monitoring(TDM)and the therapeutic regimen of teicoplanin in our hospital,and provide references for rational use of teicoplanin.Methods:Data of patients who used teicoplanin and carried out TDM during the course of treatment from December 2017 to December 2018 in our hospital were collected.The distribution of teicoplanin concentrations and the application of teicoplanin were analyzed retrospectively in order to clarify the relationship between the therapeutic regimen and the standard concentration of teicoplanin and its influential factors.Results:There were a total of 214 patients with 357 cases of TDM in this study.The percentage of samples with standard teicoplanin concentrations(>10μg·mL-1)was 43.4%.The most common treatment regimen of teicoplanin(43.5%)was 0.4 g every 12 hours for 3 doses and then 0.4 g once a day,which had a rate of reaching standard plasma concentration as 22.0%during the early period of treatment(on days 2-6).And the rate of reaching standard plasma concentration of the regimen with loading dose of 0.4 g every 12 hours for 5 doses and 0.4 g every 12 hours for at least 3 days were 35.6%and 68.4%respectively during the early period of treatment.The rate of reaching standard plasma concentration of teicoplanin could be increased by using high daily dose of teicoplanin during the early period of treatment.The creatinine clearance rate and cumulative dose/weight were found to be correlated with the standard concentration of teicoplanin(P<0.05).Conclusion:In clinic,the plasma concentration of teicoplanin less achieved target and had big individual differences.It was necessary to increase the initial dose of teicoplanin to assure clinical efficacy.TDM of teicoplanin was important to optimize the individual regimen of teicoplanin.