摘要
目的寻找影响重症肺炎患者应用万古霉素后血药谷浓度变化的因素并进行分析,为设计更加合理的个体化给药方案提供依据。方法选取2015年7月至2016年6月收住本院重症监护病房(ICU)的48例应用万古霉素治疗的重症肺炎患者,收集万古霉素血药谷浓度,治疗前至治疗后3 d内进行肾功能指标检测,考察万古霉素给药方案的临床疗效及内生肌酐清除率(CCR)对血清谷浓度的影响。结果 48例重症肺炎患者的谷浓度与年龄、体质量、血清白蛋白、万古霉素单位剂量、CCR的变化均线性相关(P均<0.05)。其中随着肾清除率增加,CCR>130[m L/(min·1.73 m^2)]的患者对于血清谷浓度具有显著性影响(P<0.05)。经调整给药方案后,不同肾功能状态的患者均可达到相同的临床疗效,有效率比较差异无统计学意义(P>0.05)。结论万古霉素治疗重症肺炎时,患者CCR是谷浓度的独立影响因素,在根据血清谷浓度监测结果调整给药方案后,不同肾功能状态的患者可以达到的临床疗效均较好。
Objective To analyze the influence factors on vancomycin serum trough concentration in patients with severe pneumonia in order to provide a reasonable references for personalized medication.Methods Forty-eight patients with severe pneumonia in intensive care unit（ICU） were enrolled from July 2015 to June 2016.The rate of serum trough concentration was collected,the renal function was detected,and the impact of creatinine clearance rate（CCR）in serum trough concentration were investigated and the clinical efficacy of the regiment was evaluated.Results There were significant correlation between age,weight,serum albumin level,CCR,dose of vancomycin per kilogram of body weight per day and serum trough concentration（both P〈0.05）.Patients with CCR〉130[m L/（min · 1.73 m^2）]showed relatively significant influences to serum trough concentration（P〈0.05）.After adjusting dose,patients with different renal function could still achieve the same efficacy,there was no significant difference in effective rate（P〉0.05）.Conclusion CCR was an independent influencing factor for serum trough concentration of vancomycin,and patients with different renal function could achieve ideal efficacy giving the individualized regiment.
作者
代伟
陈瑞祥
温瑾
杨梅芳
DAI Wei;CHEN Rui-xiang;WEN Jin;YANG Mei-fang(Department of Pharmacy, the third people＇s Hospital of Yunnan Province, Kunming , Yunnan 650011;Guandu District People＇s Hospital of Kunming City, Kunming , Yunnan 650011, China)
出处
《热带医学杂志》
CAS
2018年第6期795-798,834,共5页
Journal of Tropical Medicine
关键词
肺炎
万古霉素
血药谷浓度
内生肌酐清除率
Pneumonia
Vancomycin
Serum trough concentration
Creatinine clearance rate
