伏立康唑静脉给药致患者急性肾损伤的临床特征分析

Analysis of Clinical Characteristics of Acute Kidney Injury Caused by Intravenous Voriconazole

目的:分析伏立康唑静脉给药致患者急性肾损伤(acute kidney injury,AKI)的流行病学特点,为临床伏立康唑的用药安全提供参考。方法:选取2020—2022年焦作市人民医院上报的87例伏立康唑静脉给药致AKI药物不良反应报告作为研究资料,采集患者的年龄、性别、诊断,伏立康唑的用法用量和联合用药情况,以及AKI的发生时间、严重程度和转归情况等信息,分析伏立康唑所致AKI的临床特点。结果:87例伏立康唑所致AKI患者中,性别上男性明显多于女性(59例vs 28例),年龄上以≥60岁的老年患者为主(66例,占75.86%),而诊断上以肺部感染为主(64例,占73.56%),其余也多为以肺部感染为基础的混合感染(22例,占25.29%);在伏立康唑的用法用量方面,多数(52例,占59.77%)患者采用了首剂量加倍,而维持剂量以“0.2 g,q12h”为主(64例,占73.56%);此外,绝大多数(84例,占96.55%)患者存在与其他药物联用的情况;按照KGIGO分期,大多数患者的AKI为1期(62例,占71.26%);大多数患者的AKI发生于使用伏立康唑的7 d内(67例,占77.01%),而其中发生于用药后3 d内的有34例(占39.08%);87例发生AKI的患者中,45例采取了立即停药处理,其余42例未进行停药处理,最终死亡的病例有18例。结论:伏立康唑静脉给药所致AKI多发生于男性和老年患者中,此外AKI存在较高的死亡率,临床应加强用药宣教和监测,以保障患者的用药安全。

Objective:To analyze the epidemiological characteristics of acute kidney injury(AKI)caused by intravenous voriconazole in patients,and provide a reference for the clinically safe medication of voriconazole.Methods:A total of 87 adverse drug reaction reports of AKI caused by intravenous voriconazole reported by Jiaozuo People's Hospital from 2020 to 2022 were selected as research data.The data of patients such as age,sex,diagnosis,usage and dosage of voriconazole,and drug combination,as well as the occurrence time,severity and outcome of AKI were collected to analyze the clinical characteristics of AKI caused by voriconazole.Results:Among the 87 patients with AKI caused by voriconazole,the number of males was significantly higher than that of females(59 cases vs 28 cases),and the majority of patients were the elderly over and equal to 60 years old(66 cases,75.86%);most patients were diagnosed with pulmonary infection(64 cases,73.56%),and the rest were mostly with mixed infections based on pulmonary infection(22 cases,25.29%).In terms of the usage and dosage of voriconazole,most patients(52 cases,59.77%)doubled the first dose,and the maintenance dose was mainly"0.2 g,q12h"(64 cases,73.56%).In addition,the vast majority(84 cases,96.55%)of patients had combined use of other drugs.According to the KGIGO staging,most patients belonged to AKI stage 1(62 cases,71.26%).The AKI occurred within 7 days after use of voriconazole for most patients(67 cases,77.01%);and in 34 patients(39.08%),the AKI occurred within 3 days after administration.Among the 87 patients with AKI,the drugs were discontinued immediately in 45 cases,while the drugs were not discontinued in the remaining 42 cases;finally 18 cases died.Conclusion:AKI caused by intravenous voriconazole mostly occurs in male and elderly patients.In addition,AKI has a high mortality rate.Clinical education and monitoring should be strengthened to ensure the medication safety for patients.