ICU患者万古霉素血药浓度监测结果分析

Analysis of the Monitoring Results of Vancomycin Serum Concentration in ICU Patients

目的对万古霉素血药浓度监测结果进行分析,促进临床万古霉素的合理化个体化给药。方法收集上海交通大学医学院附属第一人民医院2017年5月至2019年5月ICU静脉使用万古霉素的76例患者临床资料,回顾性分析万古霉素血药浓度变化情况。结果76例患者中有49例(64.5%)送检血样监测血药浓度(其中3例为血透患者,本研究将这3例排除),27例(35.5%)未测血药浓度。46例患者年龄18-84岁,平均(56.00±15.50)岁,其中最高谷浓度为45.13mg/L,最低谷浓度为1.57 mg/L,平均谷浓度(10.74±9.41)mg/L。按照《万古霉素临床应用中国专家共识(2011版)》,建议谷浓度应维持在10-20mg/L。在46例血药浓度监测中,有32例(69.6%)谷浓度<10 mg/L,有7例(15.2%)谷浓度在10-20mg/L之间,有7例(15.2%)谷浓度>20mg/L。有1例患者出现皮疹而停药,对症处理后好转,4例患者治疗后出现万古霉素相关性肾损,发生率为8.69%。结论万古霉素监测力度不足且万古霉素治疗浓度达标率较低,大部分ICU患者病理生理改变,导致万古霉素给药后出现较大的个体差异。应重视临床药师与临床医师的沟通与合作,加强万古霉素的监测力度,根据谷浓度调整剂量,促进临床万古霉素高效低毒的使用。

Objective To analyze the monitoring results of Vancomycin serum concentration and promote the rational and individualized use of Vancomycin.Methods Clinical data of 76 patients who received Vancomycin intravenously in ICU from May 2017 to May 2019 in the First Affiliated People's Hospital of Shanghai Jiao Tong University School of Medicine were collected,and the changes of Vancomycin serum concentration were retrospectively analyzed.Results Of the 76 patients,49(64.5%)blood samples were sent to monitor blood drug concentration(Three of them were hemodialysis patients,which were excluded in this study),and 27 cases(35.5%)were not detected.The 46 patients were aged between 18 and 84 years old,with an average age of(56.00±15.50)years old.The average valley concentration was(10.74±9.41)mg/L,with the highest reaching 45.13mg/L and the lowest 1.57 mg/L.According to the Chinese Expert Consensus on the Clinical Application of Vancomycin(2011 edition),it is recommended that the valley concentration should be maintained between10-20mg/L.Among the 46 cases monitored,32(69.6%)had a trough concentration<10 mg/L,7(15.2%)had a trough concentration between 10-20mg/L,and 7(15.2%)had a trough concentration>20mg/L.One patient developed a rash and withdrew the drug,which improved after symptomatic treatment.And 4 patients developed Vancomycin associated renal impairment after treatment,with an incidence of 8.69%.Conclusion The monitoring intensity of Vancomycin in our hospital is insufficient,and the standard rate of Vancomycin treatment concentration is low.Most ICU patients have pathophysiological changes,leading to great individual differences after Vancomycin administration.Communication and cooperation between clinical pharmacists and clinicians need to be improved to strengthen the monitoring of Vancomycin and adjust the dose according to the valley concentration,in order to promote the rational use of Vancomycin with high efficiency and low toxicity.