腹透相关性腹膜炎患者万古霉素腹腔内给药后的血药浓度影响因素分析

Influencing factors of blood concentration of vancomycin after intraperitoneal administration in patients with peritoneal dialysis related peritonitis

目的监测腹透相关性腹膜炎(PDRP)患者万古霉素腹腔内给药后的血药浓度,并分析相关影响因素。方法选取2017年10月至2021年1月在邵阳学院附属第一医院行腹腔内给予万古霉素且监测血药浓度的45例PDRP患者进行分析,万古霉素腹腔内给药方案为体质量≤60 kg者1 g/次,体质量>60 kg者20 mg·kg^(-1)给药(每次剂量不超过2 g),给药后第3日采血监测血药浓度,根据血药浓度分为高血药浓度组(≥15μg·mL^(-1))及低血药浓度组(<15μg·mL^(-1)),比较两组一般资料及实验室指标,多因素Logistic回归分析影响万古霉素血药浓度的因素。结果45例接受万古霉素治疗且血药浓度监测者中高血药浓度者13例,低血药浓度者32例。万古霉素高血药浓度组患者少尿或无尿比例显著高于低血药浓度组(P<0.05),而每日腹透液交换次数则显著低于低血药浓度组(P<0.05)。Logistic回归分析发现,每日腹透液交换次数是影响万古霉素血药浓度的独立危险因素(P<0.05)。每日腹透液交换次数相同时,少尿或无尿患者万古霉素血药浓度值与尿量正常患者比较差异无统计学意义。随着每日腹透液交换次数的增加,尿量正常患者万古霉素血药浓度呈降低趋势(P<0.05)。结论PDRP腹腔内万古霉素给药后的血药浓度有个体差异,在优化患者万古霉素腹腔内给药时需考虑每日腹透液交换次数,当每日腹透液交换次数增加时,应适当增加万古霉素给药剂量或增加给药频率并加强监测,以便血药浓度达标。

Objective To monitor the blood concentration of vancomycin in patients with peritoneal dialysis associated peritonitis(PDRP)after intraperitoneal administration,and to explore the related factors for the blood concentration of vancomycin.Methods Totally 45 patients with PDRP who received vancomycin intraperitoneally and blood concentration monitoring in our hospital from October 2017 to January 2021 were selected and analyzed.According to the blood concentration,the intraperitoneal administration scheme of vancomycin was 1 g each time for those with body mass<60 kg,or 20 mg·kg^(-1) each time for those with body mass>60 kg(the dose each time was less than 2 g).Blood samples were taken on the third day after the administration to monitor the blood concentration,which were divided into a high blood concentration group(≥15μg·mL^(-1))and a low blood concentration group(<15μg·mL^(-1)).The general data and laboratory indexes of the two groups were compared and multivariate Logistic regression was used to analyze the related factors for vancomycin blood concentration.Results Among the 45 patients,13 had high blood drug concentration and 32 had low blood drug concentration.The proportion of low urine volume or anuria in the high concentration group was significantly higher than that in the low group(P<0.05).The number of daily peritoneal dialysis fluid exchange in the high concentration group was significantly lower than that in the low concentration group(P<0.05).Multivariate Logistic regression analysis showed that daily exchange of peritoneal dialysis fluid was an independent risk factor for vancomycin concentration(P<0.05).When the exchange times of abdominal pain were the same every day,there was no significant difference in the vancomycin plasma concentration between patients with oliguria or anuria and patients with normal urine volume.With the increase of daily peritoneal dialysis exchange,the blood concentration of vancomycin decreased in patients with normal urine volume(P<0.05).Conclusion The blood concentration of vancomycin in PDRP after intraperitoneal administration is different individually,so the daily exchange of peritoneal dialysis fluid should be considered when optimizing the intraperitoneal administration of vancomycin.When increasing the number of daily exchanges of peritoneal dialysis fluid during the treatment,the dose or the administration frequency should be increased strengthening as well as the monitoring.