决策树支持下SmartDose在神经外科万古霉素个体化用药中的应用

Application of Smart Dose in the individualized use of vancomycin in neurosurgery under the support of decision tree

目的评估Smart Dose个体化给药决策支持系统应用于我院神经外科万古霉素治疗药物的临床效用。方法收集2021年2月至10月在遵义市第一人医院神经外科住院并静脉使用万古霉素的患者作为研究对象,根据刘剑敏团队建立的万古霉素血药浓度解读决策树为基础,采用Smart Dose软件预测患者万古霉素谷浓度及临床使用剂量,分析谷浓度预测值与实测值之间的差异,并与未使用该软件预测谷浓度的患者进行统计分析比较,从而评价Smart Dose软件对万古霉素血药浓度的预测效能及辅助临床制定个体化给药方案的可行性。结果根据决策树标准筛选后,113例进行血药浓度分层解读。万古霉素血药浓度在5~<10 mg/L有33例(29.2%),达到治疗窗浓度10~20 mg/L的有62例(54.9%),>20 mg/L有18例(15.9%)。51例血药浓度采用Smart Dose软件辅助调整给药方案,38例被临床采纳并进行了万古霉素血药浓度复查。谷浓度预测准确率为100%;与未采纳调整方案的患者相比,具有较高的临床好转率(92.1%vs 53.9%,P<0.05)、较低的肾毒性发生率(0 vs 15.38%,P<0.05)、较短的用药疗程(14.3 d vs 19.6 d,P<0.05)及较少的药物治疗费用(3159.6元vs 5239.4元,P<0.05)。结论在决策树支持下并已获得万古霉素稳态谷浓度监测结果的基础上,SmartDose系统对万古霉素血药浓度具有较好的预测能力,可用于辅助临床制定万古霉素个体化给药方案。

Objective To evaluate the clinical efficacy of Smart Dose individualized drug administration decision support system in the treatment of vancomycin in neurosurgery.Methods The research objects were patients hospitalized in the neurosurgery department of Zunyi First People's Hospital,who used vancomycin intravenously from February to October 2021.The Smart Dose software was used to predict the valley concentration and clinical use dose of vancomycin in patients based on the interpretation decision tree of vancomycin blood concentration established by Liu Jianmin's team.The difference between the predicted valley concentration and measured value was analyzed,and statistical analysis and comparison were carried out with patients who did not use the software to predict the trough concentration.Results After screening according to the decision tree criteria,113 cases were analyzed by blood drug concentration stratification.of these,33 cases(29.2%)had a vancomycin plasma concentration of 5~<10 mg/L,62 cases(54.9%)had a vancomycin plasma concentration of 10~20 mg/L,and 18 cases(15.9%)had a vancomycin plasma concentration of>20 mg/L.The blood drug concentration of 51 cases was adjusted with Smart Dose software,and 38 cases were clinically accepted and the blood drug concentration of vancomycin was rechecked.The prediction accuracy of valley concentration is 100%.Compared with the patients who did not adopt the adjustment plan,the group using Smart Dose had a higher clinical improvement rate(92.1%vs 53.9%,P<0.05),a lower incidence of nephrotoxicity(0 vs 15.38%,P<0.05),a shorter course of medication(14.3 vs 19.6 days,P<0.05)and a lower drug treatment cost(3159.6 yuan vs 5239.4 yuan,P<0.05).Conclusion The Smart Dose system has a good prediction ability for vancomycin plasma concentration with the support of decision tree and on the basis of the monitoring results of vancomycin steady-state valley concentration.It can be used to assist the clinical formulation of individualized vancomycin administration plans.