严重肾功能不全合并感染患者不合理应用万古霉素分析

Analysis of Irrational Use of Vancomycin on Infected Patients with Severe Renal Dysfunction

目的 :探讨严重肾功能不全合并感染的患者合理应用万古霉素的有效措施。方法 :应用美康公司开发的药动学软件 ,结合血药浓度监测及临床体征 ,对3例严重肾功能不全合并感染的患者应用万古霉素的不合理性及原因进行分析。结果 :用药不合理主要表现为未遵循首剂饱和原则、未能因半衰期的改变正确调整用药间隔、对血液透析不能有效清除体内万古霉素的概念不清。结论 :只有制订并实施万古霉素应用的限制性措施、临床药师参与用药方案的制订、加强血药浓度的监测等有效措施 。

OBJECTIVE:The aim of this study was to assess the irrational use of vancomycin to treat infections of the patients with severe renal dysfunction.METHODS:Combining the results of blood concentration monitoring for vancomycin and the clinical symptoms with Micromedex Kinetidex,we evaluated whether the vancomycin was administered rationally when the infected patients with severe renal dysfunction were treated.RESULTS:It really existed that the vancomycin was irraˉtionally used among these three patients:①The first loading doses did not match the saturation principle.②Administration interval did not be regulated in time along with the T 1/2 change.③The clinical doctors did not clearly understand that the hem_ odialysis can not efficiently remove vancomycin from the blood.CONCLUSION:For the infected patients with severe renal dysfunction,it is necessary to monitor the serum concentration of vancomycin in order to insure the rational use of vancomycin to treat these infected patients.