重症患者不同负荷方案替考拉宁血药浓度结果分析

Analysis of the blood concentration of teicoplanin in severely ill patients under different load regimes

目的探索重症患者不同负荷方案替考拉宁的血药浓度达标率和影响因素,为重症患者合理使用替考拉宁提供参考。方法选取2019年3月至12月本院普外科ICU病房收治的疑似或确诊多重耐药革兰氏阳性菌(G+)感染的患者共40例。按照相同负荷剂量不同负荷次数,将患者分为高负荷组(800 mg q12 h负荷3次,维持800 mg qd,n=15)、中负荷组(800 mg q12 h负荷2次,维持800 mg qd,n=12)和未负荷组(800 mg qd,n=13)。比较3组患者替考拉宁第6剂给药前谷浓度Cmin值、Cmin达标率和血药浓度影响因素。结果中负荷组的Cmin和Cmin达标率与未负荷组相比,差异均无统计学意义[(11.92±4.01)mg·L-1 vs(11.04±4.22)mg·L-1,P>0.05;66.7%vs 61.5%,P>0.05];高负荷组的Cmin值高于未负荷组[(16.58±8.87)mg·L-1 vs(11.04±4.22)mg·L-1,P<0.05],高负荷组的Cmin达标率高于未负荷组,但差异无统计学意义(80.0%vs 61.5%,P>0.05)。多重线性回归分析结果显示,肌酐清除率与Cmin显著负相关。结论重症患者使用替考拉宁时,建议适当增加负荷给药次数,维持给药剂量需根据患者的肌酐清除率调整,以提高目标浓度达标率。

Objective To explore the blood plasma concentration compliance rate and influencing factors of teicoplanin in severely ill patients with different load regimes,and to provide reference for the rational use of teicoplanin in severely ill patients.Methods From March 2019 to December 2019,a total of 40 patients with suspected or confirmed multi-drug resistant Gram-positive bacteria(G+)infection in our general surgery ICU ward were selected.According to the same load dose and different load times,the patients were divided into high-load group(800 mg q12 h load three times,maintain 800 mg qd,n=15),medium-load group(800 mg q12 h load twice,maintain 800 mg qd,n=12)and unloaded group(800 mg qd,n=13).The trough concentration Cmin before the sixth dose,compliance rate of Cmin and the influencing factors of plasma concentration in the three groups were compared.Results Compared with the unload group,the value of Cmin and compliance rate of Cmin in the medium-load group were not statistically different[(11.92±4.01)mg·L-1 vs(11.04±4.22)mg·L-1,P>0.05;66.7%vs 61.5%,P>0.05].The value of Cmin in the high-load group was higher than that of unloaded group[(16.58±8.87)mg·L-1 vs(11.04±4.22)mg·L-1,P<0.05].The compliance rate of Cmin in the high-load group was higher than that of unloaded group(80.0%vs 61.5%,P>0.05).The results of multiple linear regression analysis showed that the creatinine clearance rate was negatively correlated with Cmin.Conclusion When using teicoplanin in severely ill patients,we recommend to increase the number of load administrations appropriately.The maintenance administration dosage should be adjusted according to the patients’creatinine clearance rate,to increase the compliance rate of target concentration.