万古霉素抗感染治疗患者血药浓度的监测与分析

Monitoring and Analysis of Blood Drug Concentration in Vancomycin Anti-infective Patients

目的分析万古霉素在抗感染治疗的过程中对患者血药浓度的监测结果。方法为方便调查研究,选择采用随机抽选的方法将2018年1月至2019年7月来我院进行治疗的感染患者100例作为本文的调查对象,所有患者均通过万古霉素进行抗感染治疗,并同时通过采用相酶放大免疫方法对万古霉素的血药浓度进行监测,并且分析患者通过万古霉素治疗以后血药浓度监测的结果和病原菌分布状况,了解相关耐药性等。结果本文所抽取的100例患者来自于我院的各个科室,病原学检测送检91例,占91.00%;万古霉素对绝大多数的革兰阳性菌敏感,并存在1株屎肠球菌耐药万古霉素;首次监测万古霉素浓度<10~20μg/mL的患者51例次,占51.00%,19例次重症感染患者对万古霉素剂量调整以后进行二次血药浓度监测,14例次患者的浓度仍<10~20μg/mL,二次血药浓度的监测和首次血药浓度监测进行比较,结果存在明显的转化,P<0.05。本文万古霉素抗感染治疗失败患者23例,还有4例患者存在万古霉素相关不良反应,停药之后好转。结论通过对万古霉素血药浓度的监测可以有效指导临床安全用药,但是万古霉素应用存在较大的个体差异性,产生影响因素也较多,因此临床医师和相关药师要对此予以关注和重视。

Objectives To monitor and analyze the plasma concentration of vancomycin in the process of anti-infective treatment.Methods In order to facilitate the investigation and study,100 patients with infections who came to our hospital from January 2018 to July 2019 were selected as random subjects.All patients were treated with vancomycin for anti-infective treatment.At the same time,the blood concentration of vancomycin was monitored by phase-enzyme amplification immunoassay,and the results of blood drug concentration monitoring and pathogen distribution after vancomycin treatment were analyzed to understand the related drug resistance.Results The 100 patients in this study were from various departments of our hospital.91 patients were sent for pathogenic detection,reaching 91.00%.Vancomycin was sensitive to most Gram-positive bacteria,and there was 1 strain of Enterococcus faecium.Vancomycin;51 patients with vancomycin concentration<10-20μg/mL for the first time,accounting for 51.00%,19 patients with severe infections were monitored for vancomycin dose after adjusting for the second blood concentration,14 cases The concentration of the second patient was still<10-20μg/mL.The monitoring of the second blood concentration was compared with the first blood concentration monitoring.The results showed significant transformation,P<0.05.In this paper,23 patients with vancomycin anti-infective treatment failed.There were also 4 patients with vancomycin-related adverse reactions,which improved after stopping the drug.Conclusion The monitoring of vancomycin blood concentration can effectively guide the clinical safety of drugs,but there are large individual differences in the application of vancomycin,and there are many influencing factors,so clinicians and related pharmacists should pay attention to it and pay attention to it.