肾功能亢进对(去甲)万古霉素治疗结局的影响

Effects of augmented renal clearance on the outcome of vancomycin/norvancomycin

目的 研究肾功能亢进(ARC)对神经外科患者应用万古霉素/去甲万古霉素治疗结局的影响。方法 分析某院神经外科收治的应用万古霉素/去甲万古霉素治疗的住院患者,根据患者的肌酸酐清除率(CrCl)分为ARC组(ARC患者,CrCl>130 mL·min^(-1)·1.73 m^(-2))和非ARC组(非ARC患者,CrCl≤130 mL·min^(-1)·1.73 m^(-2))。对患者的年龄、性别、体质量指数、体表面积、实验室检查指标、诊断情况、高血压、糖尿病及高脂血症共病情况、应用血管活性药物及利尿药情况进行倾向性评分匹配,使2组的基线情况可比,比较2组临床结局差异。结果 匹配后,ARC组与非ARC组每组各256例患者。ARC组和非ARC组的出院日常生活评定能力得分分别为(77.07±25.78)和(81.41±20.72)分,住院时间分别为31.00(23.00~43.00)和24.00(18.00~30.50)d,重症监护病房住院时间分别为6.90(0.00~18.37)和4.30(0.00~13.48)h,呼吸机使用时间分别为0.00(0.00~2.00)和0.00(0.00~1.00)h,差异均有统计学意义(均P<0.05)。结论 ARC会影响神经外科应用万古霉素/去甲万古霉素患者的治疗结局,临床上需根据ARC情况对其进行血药浓度监测和剂量调整,以期得到更好的治疗结局。

Objective To investigate the effects of augmented renal clearance(ARC)on the outcome of vancomycin/norvancomycin treatment in neurosurgery patients.Methods To analyze the inpatients treated with vancomycin/norvancomycin in the neurosurgery department of a hospital,according to their creatinine clearance rate(CrCl),the patients were divided into ARC group(ARC patients,CrCl>130 mL·min^(-1)·1.73 m^(-2))and non-ARC group(non-ARC patients,CrCl>130 mL·min^(-1)·1.73 m^(-2)).Then,we calculated the propensity score(PS)of the individual group using patients’age,gender,body mass index,body surface area,laboratory test results,diagnosis,comorbid conditions(i.e.hypertension,diabetes and hyperlipidemia),vasoactive drugs as well as diuretics.After PS-based matching the baseline conditions of the two groups were comparable,we compared the difference of clinical outcome between the two groups.Results After PS-based matching,there were 256 patients in ARC group and 256 patients in non-ARC group.The ARC group and the non-ARC group discharge daily living rating scores were(77.07±25.78)and ( 81. 41 ± 20. 72);duration of hospital stay was 31. 00 ( 23. 00 - 43. 00) and 24. 00 ( 18. 00 - 30. 50) d;thelength of stay in intensive care unit was 6. 90 ( 0. 00 - 18. 37) and 4. 30 ( 0. 00 - 13. 48) h;duration of ventilator usewas 0. 00 ( 0. 00 - 2. 00) and 0. 00 ( 0. 00 - 1. 00) h,respectively. The differences of above indexes were statisticallysignificant between two groups ( all P < 0. 05) . Conclusion ARC may affect the outcome of patients treated withvancomycin /norvancomycin in neurosurgery patients. In clinical practice,it is necessary to monitor the plasmaconcentration and dose of vancomycin /norvancomycin according to the ARC situation,in order to achieve a betterclinical outcome.