老年肺部感染患者不同剂量去甲万古霉素谷浓度分析

Analysis of trough concentrations of different norvancomycin dosages in elderly patients with pulmonary infection

目的比较不同剂量去甲万古霉素治疗老年肺部感染患者的血药谷浓度。方法将34例老年肺部感染患者按给药剂量分为对照组11例和试验组23例。对照组给予去甲万古霉素每次0.4 g,q12 h,静脉输注;试验组给予去甲万古霉素每次0.4 g,q8 h,静脉输注。2组患者均治疗4~20 d。比较2组患者的临床疗效、去甲万古霉素稳态血药谷浓度和血药谷浓度分布范围,以及药物不良反应的发生情况。结果治疗后,试验组和对照组的有效率分别为60.87%(14例/23例)和100.00%(11例/11例),平均血药谷浓度分别为(16.13±8.55)和(9.78±5.04)μg·mL^(-1),差异均有统计学意义(均P<0.05)。试验组和对照组的血药谷浓度分别为波动于1.18~32.40和1.58~20.64μg·mL^(-1)。对照组发生的药物不良反应以肾功能损伤伴发热为主,试验组发生的药物不良反应以肾功能损伤、皮疹和胃肠道反应为主。试验组和对照组的总药物不良反应发生率分别为17.39%和9.09%,差异无统计学意义(P>0.05)。结论老年肺部感染患者用去甲万古霉素静脉治疗时,血药谷浓度个体差异大,应尽量选择较小的有效剂量进行治疗。

Objective To compare the trough concentrations of different doses of norvancomycin in the treatment of elderly patients with lung infection. Methods Thrity-four elderly patients with pulmonary infection were divided into control group(11 cases) and treatment group(23 cases) according to the dosages of norvancomycin. The control group was given norvancomycin 0.4 g, q12 h, intravenous infusion. The treatment group was given norvancomycin 0.4 g, q8 h, intravenous infusion. Patients in both groups were treated for 4-20 days. The clinical efficacy, steady-state trough concentration and distribution range of trough concentration of norvancomycin, and the occurrence of adverse drug reactions were compared between the two groups. Results After treatment, the effective rates of treatment group and control group were 60.87%(14 cases/23 cases) and 100.00%(11 cases/11 cases), and the average trough concentrations were(16.13±8.55) and(9.78±5.04) μg·mL^(-1), the differences were statistically significant(all P<0.05). The trough concentration of treatment group and control group fluctuated between 1.18-32.40 and 1.58-20.64 μg·mL^(-1),respectively. The adverse drug reactions in the control group were mainly renal impairment with fever,and which in the treatment group were mainly renal impairment,skin rash and gastrointestinal reactions. The incidences of total adverse drug reactions in treatment group and control group were 17. 39% and 9. 09%,respectively,without statistically significant difference( P > 0. 05). Conclusion When the elderly patients with lung infection are treated with norvancomycin intravenously,the trough concentration varies greatly among individuals,and the smaller effective dose should be selected as far as possible.