摘要
目的:探究万古霉素血药浓度的检测对耐药革兰阳性菌感染患者用药剂量合理控制的影响,为合理使用万古霉素提供参考。方法:选取2015年7月—2018年1月间收治的耐药革兰阳性菌感染患者112例资料,统计其使用万古霉素治疗并在治疗期间实施血药浓度检测的结果,分析万古霉素血药浓度检测结果及其不同谷浓度对临床疗效与安全性的影响。结果:112例患者血药浓度检测结果显示,其中37例血药浓度位于靶-谷浓度分布区间(10～20μg/mL)占33.04%);依据检测结果,44例患者调整了后续用药剂量,其中20例谷浓度<5μg/mL,增加日用药剂量15例;而18例谷浓度>20μg/mL,减少了日用药剂量12例;此外,出现剂量调整错误病例2例,如1例谷浓度<5μg/mL者减少了日用药剂量和1例谷浓度是在16～20μg/mL区间者增加日用药剂量;选取指征性治疗患者30例,通过万古霉素低浓度组(<10μg/mL)与高浓度组(≥10μg/mL)临床效果相比其差异无统计学意义(P>0.05);30例指征性治疗患者中发生不良反应4例(2例肾毒性反应、1例红人综合征和1例耳毒性反应),主要集中于血清谷浓度大于20μg/mL患者中。结论:对耐药革兰阳性菌感染患者,采用万古霉素治疗时,应检测其血药浓度有助于用药剂量合理控制,以降低不良反应发生的风险。
Objective: To explore the influence of vancomycin blood concentration detection on rational control of drug dosage in patients with drug-resistant Gram-positive bacteria infection, and to provide a reference for the rational use of vancomycin. Methods: The data of 112 patients with drug-resistant Gram-positive bacteria infection admitted from July 2015 to January 2018 were selected, and the results of vancomycin blood concentration test during the treatment were statistically analyzed. The results of vancomycin blood concentration test and the effects of different concentrations of vancomycin on clinical efficacy and safety were analyzed. Results: The blood concentration test results of 112 patients showed that the blood concentration of 37 patients was located in the target-valley concentration distribution range(between 10 and 20 g/mL)(33.04%). According to the test results, in 44 patients was adjusted the follow-up dose;including 20 patients with the valley concentration were greater than 5 g/mL and 15 patients was increased the daily dose. In 18 cases, the daily dose was reduced by greater than 20 g/mL. In addition, there were 2 patients with dose adjustment errors, i.e., in 1 patient with valley concentration were Less than 5 g/mL was decreased daily dose and in 1 patient with valley concentration between 16 and 20 g/mL was increased daily dose.Thirty patients with symptomatic treatment were selected,and the difference in clinical effect between the vancomycin low concentration group(Less than 10 g/mL) and the high concentration group(10 g/mL) was not statistically significant(P>0.05). Adverse reactions occurred in 4 of the 30 patients(2 with nephrotoxicity, 1 with erythrosis and 1 with ototoxicity). It was mainly concentrated in patients with serum valley concentration greater than 20 g/mL. Conclusion: For patients with drug-resistant Gram-positive bacteria infection,when vancomycin is used for treatment, the blood drug concentration should be tested, which is beneficial to the rational control of dosage, so as to reduce the risk of adverse reactions.
作者
安玉英
张风林
An Yu-ying;ZHANG Feng-lin(Department of Pharmacy,Puyang People's Hospital,Puyang He'nan 457000,China)
出处
《抗感染药学》
2019年第3期394-397,共4页
Anti-infection Pharmacy
关键词
万古霉素
血药浓度
耐药革兰阳性菌感染
合理控制剂量
vancomycin
blood concentration
drug-resistant Gram-positive infection
reasonable control dosage
