重症监护病房107例患者万古霉素血药谷浓度监测回顾性分析

Monitoring plasma vancomycin concentration in 107 ICU patients:a retrospective analysis

目的:回顾性分析我院重症监护病房107例患者万古霉素的应用情况,分析其血药谷浓度的分布情况及达标率,为万古霉素合理应用提供理论参考。方法:回顾性分析2015年1月~2016年5月我院重症医学科使用万古霉素抗感染患者的资料,根据首次测定血药谷浓度时间,将患者分为A组(4~5剂给药前30 min)、和B组(6剂及以后给药前30 min),每组根据是否首剂给予负荷剂量进一步分为给予负荷剂量组以及未给予负荷剂量组两个亚组,分析各亚组血药谷浓度的分布及达标率。结果:(1)入组107例患者,共230份万古霉素血药谷浓度监测的数据,达到目标血药谷浓度(15~20 ng/m L)的有52例(22.61%)。(2)共59例患者纳入A组,共有7例患者达到目标血药谷浓度,占总人数的11.86%。其中给予负荷剂量组6例,未给予负荷剂量组1例,给予负荷剂量组目标谷浓度达标率明显高于未给予负荷剂量组(15.8%vs 4.8%)。共48例患者纳入B组,共有17例患者达到目标谷浓度,占总人数的35.4%,其中给予负荷剂量组11例,未给予负荷剂量组6例,给予负荷剂量组目标谷浓度达标率明显高于未给予负荷剂量组(44%vs 26.1%)。A组与B组比,A组目标谷浓度达标率明显低于B组(11.86%vs 35.4%)。结论:经验使用万古霉素,目标血药谷浓度达标率低,为迅速达到稳态谷浓度,有必要首剂给予负荷剂量,同时加强治疗药物浓度监测。

Objective: To review the use of vancomycin in 107 ICU patients in our hospital,with analysis on the profile of serum trough concentration and the rate of target serum trough concentration,so as to provide evidence for rational use of vancomycin. Methods: Between January 2015 and May 2016,data from ICU patients in our hospital who received vancomycin for anti-infective therapy were reviewed. The patients were divided into group A( 30 min before 4-5 doses) and group B( 30 min before 6 doses and more) based on the time to first determination of serum trough concentration. Each group was further divided into two subgroups,the loading dose subgroup and the non-loading dose subgroup,according to whether the loading dose of vancomycin was given when first use. We analyzed the profile of serum trough concentrations and the rate of target serum trough concentration of vancomycin in each subgroup. Results:( 1) A total of 107 patients were enrolled in this study,contributing to230 serum samples for monitoring of trough vancomycin concentration. Among them,52 patients( 22. 61%) had reached the target serum trough concentration( 15-20 ng/m L).( 2) A total of 59 patients were included in group A,of which 7 reached the target serum trough concentration,accounting for 11.86% of the total and comprising 6 from the loading dose subgroup and 1 from the non-loading dose subgroup. In group A,the rate of target serum trough concentration was significantly higher in the loading dose subgroup than in the non-loading dose subgroup( 15.8% vs 4.8%). A total of 48 patients were included in group B,of which 17 patients reached the target serum trough concentration,accounting for 35.4% of the total and comprising 11 from the loading dose subgroup and 6 from the non-loading dose subgroup. In group B,the rate of target serum trough concentration was significantly higher in the loading dose subgroup than in the non-loading dose subgroup( 44% vs 26. 1%). Compared with group B,the overall rate of target serum trough concentration in group A was significantly low( 11. 86% vs 35.4%). Conclusion: Empirical use of vancomycin may result in low rate of target serum trough concentration. To achieve a steady trough concentration quickly,a loading dose should be given as the first dose,and meanwhile,monitoring of the serum vancomycin concentration should be enhanced.