ICU颅内感染患者血清及脑脊液中万古霉素浓度影响因素分析

An analysis of factors influencing vancomycin concentration in serum and cerebrospinal fluid of patients with intracranial infection in ICU

目的探讨影响ICU颅内感染患者血清和脑脊液中万古霉素浓度的相关因素。方法收集48例ICU颅内感染患者的临床资料,采用简单线性回归和多重线性回归分析影响患者血清和脑脊液中万古霉素谷浓度的相关因素。结果48例患者血清万古霉素谷浓度为(19.26±8.96)mg/L,血药浓度达标率为31.25%;脑脊液万古霉素谷浓度为(4.61±2.97)mg/L,脑脊液浓度达标率为16.67%;脑脊液中万古霉素穿透率为(18.84±9.47)%。简单线性回归分析结果显示,血清中万古霉素谷浓度与肌酐和白蛋白水平均呈正向线性关系(P<0.05),而与患者年龄、体重、性别不存在线性关系(P>0.05);脑脊液中万古霉素谷浓度与患者年龄、性别、体重、肌酐、白蛋白以及脑脊液白细胞计数之间均不存在线性关系(P>0.05)。多重线性回归分析结果显示,肌酐、白蛋白水平和血清万古霉素谷浓度均与脑脊液万古霉素谷浓度呈正向线性关系(P<0.05)。结论ICU颅内感染患者万古霉素初始药物谷浓度达标率较低,采取万古霉素静脉给药治疗方案时应考虑血肌酐、白蛋白水平的影响。

Objective To explore the factors influencing vancomycin concentration in serum and cerebrospinal fluid(CSF) of the patients with intracranial infection in the intensive care unit(ICU).Methods Clinical data of ICU 48 patients with intracranial infection were collected.Simple linear regression analysis and multiple linear regression analysis were used to analyze the related factors affecting the concentration of vancomycin in serum and CSF.Results Of 48 patients, serum vancomycin drug valley concentration was(19.26±8.96) mg/L,and the blood concentration compliance rate was 31.25%.The valley concentration of vancomycin in CSF was(4.61±2.97) mg/L,the CSF concentration compliance rate was 16.67%,and the vancomycin penetration rate in CSF was(18.84±9.47)%.Simple linear regression analysis showed that serum vancomycin valley concentration had a positive linear relationship with creatinine and albumin levels(P<0.05),but there was no linear relationship with the age, weight and gender(P>0.05).There was no linear relationship between vancomycin valley concentration in CSF and the age, gender, weight, creatinine, albumin, and CSF white blood cell count(P>0.05).The results of multiple linear regression analysis showed that the levels of creatinine, albumin levels, and vancomycin valley concentrations in serum were positively and linearly related with vancomycin valley concentration in CSF(P<0.05).Conclusion The initial drug valley concentration of vancomycin in ICU patients with intracranial infection is low.When taking vancomycin intravenous administration, the effects of serum creatinine and albumin levels should be considered.