摘要
目的回顾性分析万古霉素应用于颅内感染伴肾功能亢进者的血药浓度和相关因素差异,为临床使用万古霉素进行治疗药物监测(TDM)和剂量调整提供参考。方法通过病例系统收集某三甲医院2018年1月~2022年6月接受过万古霉素静脉治疗并行万古霉素治疗药物监测病例,使用Excel表收录患者相关信息和临床检测指标等数据,使用IBM SPSS Statistics 23.0和GraphPad Prism 9软件进行统计学分析。结果纳入148名患者224例次万古霉素血药浓度监测。万古霉素谷浓度的单因素和多因素分析结果表明,年龄和血肌酐是影响万古霉素谷浓度的独立危险因素;相关性分析提示,年龄和血肌酐与万古霉素谷浓度呈正相关,肌酐清除率与万古霉素谷浓度呈负相关。而颅内感染伴ARC对万古霉素血药谷浓度的影响,结果显示,ARC组的达标率显著低于非ARC组,其中疑似颅内感染组比颅内感染组达标率更低。结论ARC是万古霉素谷浓度降低的重要原因,年龄小、体质量较高和颅内感染可以通过影响ARC间接影响万古霉素谷浓度。
OBJECTIVE To use retrospective analysis for plasma concentration and difference of correlative factors of vancomycin in patients with intracranial infection combined with augmented renal clearance(ARC),which is to provide reference for clinical use of vancomycin for therapeutic drug monitoring(TDM)and dosage adjustment.METHODS Casestreated with intravenous vancomycin therapy and concurrent therapeutic drug monitoring of vancomycin from cases system in third-class hospital with the period from January 2018 to June 2022 were collected.The data inclueded patient-related information and clinical test indicators were collected with Excel and then statistical analysis was performed with IBM SPSS Statistics 23.0 and Graph Pad Prism 9.RESULTS 224 times of vancomycin plasma concentration testing in 148 patients were included.The results of univariate and multivariate analysis of vancomycin trough concentration showed that age and serum creatinine were independent risk factors for vancomycin trough concentration.The correlation analysis of vancomycin trough concentration showed that age and serum creatinine were positively correlated with vancomycin trough concentration,while endogenous creatinine clearance rate was negatively correlated with vancomycin trough concentration.The resultsof intracranial infection with ARC on serum trough concentration of vancomycin showed that the rate of reaching the standard in ARC group was significantly lower than that in non-ARC group,and the meeting rate was lower in the suspected intracranial infection group than in the intracranial infection group.CONCLUSION ARC is an important factor for decreasing the trough concentration of vancomycin.Besides,younger age,higher body weight and intracranial infection can indirectly affect the trough concentration of vancomycin by affecting ARC.
作者
陈丽金
王若伦
缪幼思
CHEN Lijin;WANG Ruolun;MIAO Yousi(The Second Affiliated Hospital of Guangzhou Medical University,Guangzhou,Guangdong 510260,China;School of Pharmacy,Guangdong Pharmaceutical University,Guangzhou,Guangdong 510006,China)
出处
《今日药学》
CAS
2023年第10期754-759,共6页
Pharmacy Today
基金
广州市卫生健康科技项目(20231A011086)。
关键词
肾功能亢进
万古霉素
颅内感染
治疗药物监测
真实世界数据
augmented renal clearance
vancomycin
intracranial infection
therapeutic drug monitoring
real-world data
