肾功能亢进对ICU重症感染患者万古霉素血药浓度的影响分析

Analysis of influence of augmented renal clearance on vancomycin concentration in ICU patients with severe infection

目的分析肾功能亢进(ARC)对重症监护室(ICU)重症感染患者万古霉素血药谷浓度的影响,为万古霉素精准治疗提供依据。方法采取回顾性研究方法,收集2019年1月~2021年12月在徐州医科大学附属医院ICU应用万古霉素抗感染治疗并进行血药谷浓度监测的患者信息,分析重症感染患者ARC对万古霉素血药谷浓度的影响。结果共收集168例患者信息,118例万古霉素谷浓度未达标。一般线性模型分析结果表明万古霉素谷浓度与肌酐清除率呈负相关,即肌酐清除率越高,万古霉素谷浓度越低,肌酐清除率是其浓度不达标的独立影响因素。与非ARC组相比,ARC组男性更多,年龄更轻,体重更重,万古霉素谷浓度更低。结论ARC显著影响重症患者万古霉素谷浓度,临床上需要根据患者实际生理指标情况对其进行治疗方案的调整,争取得到更好的治疗效果。

Objective To analyze the influence of augmented renal clearance(ARC)on plasma concentration of vancomycin in patients with severe infection in intensive care unit(ICU),and provide basis for vancomycin precise treatment.Methods A retrospective study was conducted to collect the information of patients who received vancomycin therapy and monitored plasma concentration in the ICU of the Affiliated Hospital of Xuzhou Medical University from January 2019 to December 2021,and analyze the effect of ARC on vancomycin plasma concentration in patients with severe infection.Results A total of 168 patients were collected,118 of whom were below the standard of vancomycin valley concentration.The results of general linear model analysis showed that vancomycin plasma concentration was negatively correlated with creatinine clearance rate.The higher the creatinine clearance rate,the lower the vancomycin plasma concentration,and the creatinine clearance rate was an independent influencing factor for its substandard concentration.Compared with the non-ARC group,the ARC group had more males,were younger,heavier,and had lower vancomycin plasma concentrations.Conclusion ARC significantly affects the plasma concentration of vancomycin in severe patients.It is necessary to adjust the treatment plan according to the actual physiological indicators of patients in order to achieve better therapeutic effect.