肾脏替代治疗患者万古霉素给药方案的系统分析

Vancomycin administration in patients with renal replacement therapy:a systematic review

目的系统分析目前肾脏替代治疗(RRT)患者万古霉素的给药方案,为临床医师和药师制定万古霉素给药方案提供参考。方法检索PubMed、Embase、Cochrane Library、中国知网(CNKI)、万方数据库和中国生物医学文献服务系统(SinoMed)数据库,检索时限为从建库至2019年8月3日。纳入肾脏替代治疗患者万古霉素给药方案的研究,对不同RRT模式的给药方案进行描述性分析。结果共纳入18篇文献,分别对4类RRT患者万古霉素的给药方案做出推荐。对于间歇RRT,若透析后给药,针对高、低通量透析器的负荷剂量均推荐25 mg/kg,维持剂量分别为10.0和7.5 mg/kg。对于混合RRT,推荐给予负荷剂量15~20 mg/kg,维持剂量15 mg/kg。对于连续性RRT,推荐依据超滤率(UFR)给药,UFR=25~35 mL·kg^(-1)·h^(-1),维持剂量0.5 g q12 h。对于持续非卧床腹膜透析,若治疗全身感染,腹腔注射负荷剂量30 mg/kg,维持剂量7 mg/kg qd。若治疗腹膜炎,腹腔注射负荷剂量30 mg/kg,在每次透析后给予维持剂量1.5 mg/kg,每日4次。结论考虑RRT模式、参数的变异性较大,若临床实际与推荐方案背后的原始研究情景有差异,建议参考与原始研究场景相近的方案。给予初始给药方案后,应及时开展治疗药物监测。

Objetive To systematically review current studies on Vancomycin dosing regimen for patients undergoing renal replacement therapy(RRT),and therefore to provide reference for clinicians and pharmacists to formulate the administration of Vancomycin.Methods Electronic literature search was performed in PubMed,Embase,Cochrane Library,CNKI,Wanfang and SinoMed databases,the retrieval time was up to 3 August 2019.Vancomycin dosing regimens for different modalities of RRT were included and descriptively analyzed.Results A total of 18 studies were included.Vancomycin dosing regimens for 4 types of RRT were summarized,respectively.For intermittent RRT,the loading dose of 25 mg/kg and the maintenance dose of 10.0 and 7.5 mg/kg was recommended for high and low flux dialyzers.For hybrid RRT,the loading dose of 15-20 mg/kg and maintenance dose of 15 mg/kg was recommended.For continuous renal replacement therapy,the ultrafiltration rate(UFR)was recommended for consideration.If UFR=25-35 mL·kg^(-1)·h^(-1),maintenance dose of 0.5 g q12 h was recommended.For continuous ambulate peritoneal dialysis,the loading dose was 30 mg/kg and the maintenance dose was 7 mg/kg.If the patient was peritonitis,loading dose of 30 mg/kg and maintenance dose of 1.5 mg/kg through intraperitoneal injection was recommended.Maintenance dose was given after each dialysis,4 times a day.Conclusion Considering the variability of RRT modalities and parameters,if there is a difference between clinical practice and original research scenario behind the recommended scheme,it is suggested to adopt dosing regimen concluded from similar scenarios.And therapeutic drug monitoring should be done timely after the primary dosing regimen.