神经外科万古霉素血药浓度监测结果及影响因素

Analysis of Monitoring Results and Influencing Factors of Vancomycin Blood Concentration in Neurosurgery Department

目的通过对昆明医科大学第一附属医院神经外科颅脑术后颅内感染或/和肺部感染患者的万古霉素血药浓度监测结果进行分析,为临床合理使用万古霉素提供参考依据。方法收集119例神经外科颅内感染和/或肺部感染患者的相关信息,对万古霉素血药浓度监测结果进行统计分析,考察万古霉素谷浓度的影响因素。结果经验性给予万古霉素1g,ivgtt,q12h,血药谷浓度在参考范围(10~20 mg/L)内的仅占26.1%,低于参考范围的占68.1%,对于谷浓度影响因素进行多重线性回归分析,发现仅肌酐清除率对于万古霉素谷浓度影响有统计学意义。结论神经外科术后感染患者使用万古霉素抗感染治疗时,经验性给予1g,ivgtt,q12h的剂量可能达不到有效血药浓度,需结合患者肌酐清除率选择初始给药剂量,同时密切监测万古霉素血药浓度,及时根据患者情况结合监测结果调整给药方案。

Objective To provide reference for clinical rational use of vancomycin through analyzing the monitoring results of vancomycin plasma concentration in patients with intracranial infection or/and pulmonary infection after neurosurgery in our hospital.Methods We collected the related information of 119 neurosurgical patients with intracranial infection and/or pulmonary infection,and the monitoring results of vancomycin blood concentration and the influencing factors were analyzed.Results With the dosage of vancomycin 1 g,IVGTT,q12 h,only 26.1%of the patients were within the reference range(10-20 mg/L)and 68.1%were lower than the reference range.Multiple linear regression analysis showed that only creatinine clearance rate had significant effect on the trough concentration of vancomycin.Conclusion When patients with postoperative infection in neurosurgery are treated with vancomycin,the dosage of 1 g,IVGTT,q12 h may not reach the effective blood concentration,so the initial dosage should be selected according to the creatinine clearance rate of patients,and the blood concentration of vancomycin should be closely monitored,and the dosage regimen should be adjusted according to the situation of patients and the detection results timely.