危重症患者万古霉素血药浓度监测及对肾功能的影响研究  

Analysis of Vancomycin's Blood Concentration Monitoring and Effects of Renal Functions in Critical Patients

作　　者：许金红[1] 李永霞[1] 张胜利[2] 陈昕 鲍方[3] 王金龙 

机构地区：[1]解放军海军安庆医院药剂科,安徽安庆246003 [2]解放军海军安庆医院重症医学科,安徽安庆246003 [3]解放军海军安庆医院胸外科,安徽安庆246003

出　　处：《中国药学杂志》2016年第7期567-571,共5页Chinese Pharmaceutical Journal

摘　　要：目的探讨危重症患者万古霉素血药浓度与肾功能的相关性,为临床合理用药提供依据。方法回顾(2014.9~2015.6)64例危重症患者使用万古霉素后监测血药浓度及肾功能,对患者的临床资料(基本资料、病原学检查结果、临床疗效、万古霉素血药浓度监测、肾功能情况等)进行统计分析。结果 64例危重症患者中有40例患者查出病原菌,占62.5%;临床治疗有效率达到81.25%;万古霉素谷浓度监测79例,平均值为(17.48±13.22)μg·mL^(-1);万古霉素治疗前、后BUN、SCr无显著性差异,Ccr有显著性差异;而万古霉素谷浓度<5μg·mL^(-1)组、5~10μg·mL^(-1)组、10~20μg·mL^(-1)组与>20μg·mL^(-1)组相比,BUN、SCr和Ccr均有显著性差异。结论万古霉素在危重症患者中的应用相对谨慎。使用该药时可根据血药浓度和肾功能结果及时调整给药方案,实行个体化给药。OBJECTIVE To study the relativity between patients＇ blood concentration of vancomycin and renal function,provide references for rational clinical application. METHODS The blood concentration and renal function of 64 cases of critical patients were monitored after the usage of vancomycin,then retrospectively analyzed combined with clinical date（ basic information,bacteriological results,clinical curative effect,etc.）. RESULTS Pathogenic bacteria was detected from 40 of 64 patients,accounting for 62. 5%. The effective rate of vancomycin reached 81. 25%. The average value of 79 monitered cases of valley concentration was（ 17. 48 ± 13. 22）μg·mL（-1）. There was no significant difference of the level of BUN and Scr before and after the treatment of vancomycin,while the level of Ccr had the significant difference. There were significant difference of the level of BUN,Scr,Ccr between the groups of valley concentration 5,5- 10,10- 20 μg·mL（-1）and the group of 20 μg·mL（-1）. CONCLUSION The application of vancomycin in critical patients is relatively cautions. When using the drug,the drug concentration and renal function can be adjusted according to the results of blood concentration and renal function.

关 键 词：危重症患者 万古霉素 血药浓度监测 肾功能 

分 类 号：R969.4[医药卫生—药理学]