万古霉素血药浓度检测对烧伤总面积>50%体表总面积患者药物剂量调整的影响

Exploreation of effect of vancomycin blood concentration detection on drug dose adjustment in patients with total burn area >50% of total body surface area

目的探究万古霉素血药浓度检测对烧伤总面积>50%体表总面积(TBSA)患者药物剂量调整的影响。方法选取2018年12月—2020年3月河南省人民医院烧伤总面积>50%TBSA患者22例,入院后2 h内给予万古霉素静滴,每12 h给药1次。对比用药后血液、水泡液中药物浓度、药代动力学参数及用药前、用药后3 d肝功能指标[结合胆红素(DBIL)、总胆红素(TBIL)、谷丙转氨酶(ALT)]、肾功能指标(尿素氮、肌酐)。结果用药后1 h万古霉素血液及水泡液中浓度均达到高峰,用药后0.5 h、1 h血液中万古霉素浓度高于水泡液(P<0.05);血液中万古霉素峰浓度(Cmax)为19.58~37.08 mg/L,水泡中为15.41~27.09 mg/L;血液中t1/2β为4.10~5.43 h,水泡液中t1/2β为78.64~97.65 h;血液、水泡液中β、α、t1/2β、t1/2α、K10、K21、K12、CLs、AUC差异有统计学意义(P<0.05);22例烧伤总面积>50%TBSA患者用药前、用药后3 d肝肾功能指标(DBIL、TBIL、ALT、尿素氮、肌酐)差异无统计学意义(P>0.05)。结论烧伤总面积>50%TBSA早期应用万古霉素后,体内药代动力学差异较大,需监测药物浓度,并据此调整药物剂量,使其维持在安全有效范围。

Objective To explore the effect of vancomycin blood concentration detection on drug dose adjustment in patients with total burn area > 50% of total body surface area(TBSA). Methods From December 2018 to March 2020, 22 TBSA patients with total burn area > 50% were selected. Vancomycin was given intravenously every 12 hours within 2 hours after admission. The drug concentration, pharmacokinetic parameters in blood and blister fluid after treatment, liver function indexes [conjugated bilirubin(DBIL), total bilirubin(TBIL), alanine aminotransferase(ALT)] and renal function indexes(urea nitrogen, creatinine) before and 3 days after treatment were compared. Results The concentration of vancomycin in blood and vesicle reached the peak at 1 h after treatment, and the concentration of vancomycin in blood at 0.5 h and 1 h after treatment was higher than that of vesicle(P<0.05);The peak concentration of vancomycin in blood(Cmax) was 19.58-37.08 mg/L, and that in vesicle was 15.41~27.09 mg/L;The T1/2 β in blood was 4.10~5.43 h, and that in vesicle was 78.64~97.65 mg/L h. There were significant differences in β, α, T1/2 β, T1/2 α, K10, K21, K12, CLS and AUC in blood and blister fluid(P<0.05);There were no significant differences in liver and kidney function indexes(DBIL, TBIL, alt, urea nitrogen and creatinine) in 22 TBSA patients with total burn area > 50% before and 3 days after treatment(P>0.05). Conclusion The pharmacokinetics of vancomycin in TBSA with total burn area >50% varies greatly after early application. It is necessary to monitor the concentration of vancomycin and adjust the dosage accordingly to maintain it in a safe and effective range.