皖南医学院第一附属医院237例万古霉素血药浓度监测结果分析

Analysis of Vancomycin blood concentration monitoring in 237 cases of patients hospitalized in the first affiliated hospital of Wannan Medical College

目的通过分析本院万古霉素血药浓度的监测结果,为临床合理使用万古霉素提供参考。方法收集2019年1月—2020年12月本院住院患者使用万古霉素并进行血药浓度监测的病历资料,通过对病人的基本情况、监测科室、临床诊断、病原学检查及血药谷浓度值等进行回顾性整理、分析。结果共统计到1378例患者使用万古霉素,其中有143例患者进行了237例次万古霉素血药谷浓度监测,平均谷浓度为(24.46±17.44)mg/L,其中36.3%的监测结果在治疗窗内,低于治疗窗和高于治疗窗比例分别为14.8%、48.9%;监测比例占10.38%。监测例次排名前五位送检科室分别是肾脏内科、重症医学科、神经外科、呼吸与危重症医学科(二)、感染科。143例患者的病原学检查送检率为90.91%,其中阳性率为71.54%。按照不同年龄段分为四组,每组血药浓度均值均超出治疗窗范围,其中在有效浓度范围内占比最高的是<18岁组。结论本院万古霉素血药浓度监测比例和监测达标率均较低,临床药师应积极推广、宣传万古霉素血药浓度监测手段,参与临床万古霉素个体化治疗方案制定,进而提高抗感染疗效,避免出现耐药现象。

Objective In order to provide a reference for rational clinical use of vancomycin,we analyze the monitoring results of the blood concentration of vancomycin in our hospital.Methods The medical records of hospitalized patients adopted vancomycin and blood concentration monitoring in our hospital from 2019 to 2020 were collected.The basic situation of patients,monitoring departments,clinical diagnosis,pathogenic examination and blood drug valley concentration were analyzed retrospectively.Results According to statistics,1378 patients adopted vancomycin,of which 143 patients underwent blood drug valley concentration monitoring for 237 times.The average valley concentration was(24.46±17.44)mg/L,among them,36.3%of the monitoring results are within the therapeutic scope,and the proportions below and above the therapeutic scope are 14.8%and 48.9%,respectively;the proportion of monitoring accounted for 10.38%.The top five departments for monitoring cases are nephrology,intensive medicine,neurosurgery,respiratory and critical care medicine(Ⅱ),and infectious diseases department.The rate of pathogen examination was 90.91%in 143 patients,and the positive rate was 71.54%.They were divided into four groups according to different age,and average blood drug concentration of each group was beyond the therapeutic scope,and the highest proportion of the effective concentration range was in group younger than 18 years old.Conclusions The proportion and compliance rate of vancomycin blood concentration monitoring in our hospital are at low level.Clinical pharmacists should actively promote and publicize blood concentration monitoring methods of vancomycin,and participate in the formulation of clinical individualized treatment of vancomycin,so as to improve anti-infection efficacy and avoid drug resistance.