配置浓度与患者基础肾功能对万古霉素用药安全性的影响

Effect of Configuration Concentration and Patient’s Basic Renal Function on the Safety of Vancomycin

目的:探讨万古霉素临床使用安全性及血药浓度监测情况,为临床合理用药提供依据。方法:以2018—2019年苏州大学附属第三医院临床使用万古霉素并进行血药浓度监测的228例患者为研究对象,分析年龄、基础肾功能、药物配置浓度对万古霉素血药浓度、患者用药后肾功能的影响。结果:228例患者共监测万古霉素血药浓度394例次,其中195例次(占49.49%)万古霉素血药浓度达到治疗窗范围(10~20μg/ml)。60~70岁患者的万古霉素血药浓度均值约为26.75μg/ml,>70岁患者中万古霉素血药浓度达到治疗窗范围的比例最高,而<60岁患者中万古霉素达到中毒浓度的比例明显最高。基础肾功能可影响万古霉素血药浓度,中重度肾损伤患者的万古霉素血药浓度均值约为27.93μg/ml,高于治疗窗范围上限。不同万古霉素配置浓度与血药浓度之间无统计学相关性(P>0.05),配置浓度对血药浓度是否达标无影响。肾功能正常患者使用万古霉素治疗前后的内生肌酐清除率、尿素氮水平比较,差异有统计学意义(P<0.05);而肾功能轻度损伤、肾功能中重度损伤患者万古霉素治疗前后血肌酐、尿素氮水平比较,差异均无统计学意义(P>0.05)。万古霉素配置浓度>0.5%时,患者治疗前后内生肌酐清除率、尿素氮水平比较,差异有统计学意义(P<0.05)。万古霉素血药浓度超过治疗范围时,患者治疗前后内生肌酐清除率比较,差异有统计学意义(P<0.05)。结论:<60岁、基础肾功能正常者也存在肾损伤风险,在连续使用万古霉素期间,应增加血药浓度监测频率,并加强药学监护;万古霉素配置浓度过高可增加肾损伤的发生风险。因此,临床药师在工作中需要弥补上述疏漏,协助医师做好使用万古霉素后的患者用药监护工作。

OBJECTIVE:To probe into the medication safety and blood concentration monitoring of vancomycin,so as to provide references for clinical rational medication.METHODS:228 patients who were given vancomycin and conducted blood concentration monitoring in the Third Affiliated Hospital of Soochow University from 2018 to 2019 were selected as research object and analyzed the effects of age,basic renal function and drug configuration concentration on the blood concentration of vancomycin and renal function of patients.RESULTS:The blood concentration of vancomycin in 228 patients was monitored 394 case-times,of which 195 case-times(49.49%)had reached the therapeutic window range(10-20μg/ml).The average blood concentration of vancomycin in patients aged between 60-70 was about 26.75μg/ml,and the proportion of patients aged>70 with blood concentrations of vancomycin reaching the therapeutic window range was the highest,while the proprtion of patients aged<60 with blood concentration of vancomycin reaching toxic concentration was obviously the highest.Basic renal function could affect the blood concentration of vancomycin,the average blood concentration of vancomycin in patients with moderate to severe renal injury was about 27.93μg/ml,which was higher than the upper limit of therapeutic window.There was no statistical correlation between different configuration concentrations and blood concentration of vancomycin(P>0.05),and the configuration concentration had no effect on whether the blood concentration reached the standard.The differences in endogenous creatinine clearance rates and urea nitrogen levels before and after vancomycin treatment in patients with normal renal function were statistically significant(P<0.05);while there were no statistical significance in differences endogenous creatinine clearance rates and urea nitrogen levels before and after vancomycin treatment in patients with mild renal function and moderate to severe renal function(P>0.05).When the configuration concentration of vancomycin was>0.5%,the differences in endogenous creatinine clearance rates and urea nitrogen levels before and after treatment were statistically significant(P<0.05).When the blood concentration of vancomycin exceeds the therapeutic range,the difference in endogenous creatinine clearance rates before and after treatment was statistically significant(P<0.05).CONCLUSIONS:People age<60 years with normal basic renal function are also at risk of renal injury,during continuous use of vancomycin,the frequency of blood concentration monitoring should be increased,and pharmaceutical monitoring should be strengthened;excessively high vancomycin concentration can increase the risk of renal injury,so that clinical pharmacists need to make up for these careless omissions and assist physicians in medication monitoring of patients after using vancomycin.