某三甲医院111例次万古霉素血药浓度监测结果与临床应用分析

Analysis of 111 Cases of Vancomycin Serum Concentration Monitoring Results and Clinical Application in A Tertiary Hospital

目的:分析本院万古霉素血药浓度监测结果,为临床合理用药提供依据。方法:回顾性收集2016年7月—2022年7月我院所有符合入选、排除标准的患者65例作为研究对象,对患者的临床资料及万古霉素对其肾功能影响的相关指标进行统计,并分析万古霉素的临床应用影响因素。结果:纳入65例患者进行111例次血药浓度监测,平均谷浓度为(16.35±12.30)mg/L,首次监测血药浓度达到治疗窗(10~20mg/L)的有26例(占总体监测例次的23.4%),总体监测万古霉素血药浓度达治疗窗的有53例次(47.7%);万古霉素平均使用日剂量为(1.21±0.67)g,平均使用疗程(11.59±7.64)d,平均联合药物(0.77±0.78)种;其中日剂量小于2 g患者进行血药浓度监测的比例最大(74.8%),大于60岁组患者落在治疗窗的比例最高。18例患者血药浓度达危急值(>25mg/L)以上,有6例患者用药前后检查肾功能,其中VAN产生达危急值时患者Cr增高和eGFR下降,差异有统计学意义(P<0.05);Urea、UA比较,差异无统计学意义(P>0.05);3例达危急值患者发生肾功能损害,占总数的16.6%,其中VAN血药浓度最高为74.94 mg/L,最低为26.47 mg/L。44例VAN未达危急值时患者肾功能指标的改变见表6,其中7例(15.9%)患者发生肾功能损害,VAN血药浓度最高为24.06 mg/L,最低为11.12 mg/L。结论:万古霉素血药浓度个体差异大,尤其是肾功能不全或亢进的患者人群,该院万古霉素首次与总血药浓度达标率均较低,使用万古霉素需要加强血药浓度监测,联合患者临床情况,选择适宜的给药方案,实现个体化治疗。万古霉素及时检测以及危急值的报告能提高患者用药的安全和有效性。

Objective:To analyze the serum concentration monitoring of vancomycin in our hospital and provide references for rational clinical use.Methods:All 65 patients who met the inclusion and exclusion criteria in our hospital from July 2016 to July 2022 were retrospectively collected as study subjects.The clinical data of the patients and the influenceof vancomycin on their renal function were counted.The factors affecting the clinical application of vancomycin were analyzed.Results:A total of 1ll times of blood drug concentration monitoring were carried out in 65 patients,and the average trough concentration was(16.35±12.30)mg/L.The first monitoring blood drug concentration reached the treatment window(10-20 mg/L)in 26 cases(23.4%of the total monitoring cases),and the overall monitoring of vancomycin blood drug concentration reached the treatment window in 53 cases(47.7%).The average daily dose of vancomycin was(1.21±0.67)g,the average course of treatment was(11.59±7.64)d,and the average number of combined drugs was(0.77±0.78).Among them,patients with daily dose less than 2 g had the largest proportion of blood concentration monitoring(74.8%),and patients over 60 years old had the highest proportion of falling into the treatment window.The blood concentration of 18 patients reached a critical value(>25 mg/L).Renal function was examined in 6 patients before and after treatment.When VAN reached a critical value,Cr increased and eGFR decreased(P<0.05).Renal dysfunction occurred in 3 patients who reached the critical value,accounting for 16.6%of the total.The highest plasma concentration of VAN was 74.94 mg/L,and the lowest was 26.47 mg/L.The changes of renal function indexes in 44 patients who did not reach the critical value of VAN were shown in table 6.Among them,7 patients(15.9%)had renal function damage.The highest blood concentration of VAN was 24.06 mg/L,and the lowest was 11.12 mg/L.Conclusion:Vancomycin blood concentrations vary greatly among individuals,especially in the population of patients with renal insuficiency or hyperactivity.The first and total blood concentration attainment rates of vancomycin in this hospital are low,and the use of vancomycin requires enhanced monitoring of blood concentrations and the selection of appropriate dosing regimens for individualized treatment in conjunction with the patient's clinical situation.The timely detection of vancomycin and the reporting of critical values can improve the safety and effectiveness of patient medication.