替考拉宁在重症肺炎患者中的血药浓度监测与应用分析  

Serum concentration monitoring and application analysis of teicoplanin in patients with severe pneumonia

作　　者：吕碧君 梁峰华 谢慧[1] 肖翔林[1] 陈文瑛 

机构地区：[1]广州医科大学附属第一医院,广东广州510000 [2]佛山市南海区第六人民医院,广东佛山528200 [3]南方医科大学第三附属医院,广东广州510000

出　　处：《中国医院药学杂志》2017年第21期2167-2172,2126,共7页Chinese Journal of Hospital Pharmacy

基　　金：广州医科大学博士或留学回国人员科研项目(编号:2014C28);广东省医院药学科研基金(编号:2015SW06)

摘　　要：目的:评价分析替考拉宁在重症肺炎患者中的血药浓度范围及临床疗效。方法:前瞻性纳入某院重症医学科重症肺炎且需使用替考拉宁治疗的患者,给予替考拉宁常规负荷剂量(400 mg,q 12 h,3剂)以及维持剂量(400 mg,qd),给药后第5天收集替考拉宁稳态谷浓度血样,运用高效液相色谱法监测其浓度,统计分析血药浓度与临床疗效、细菌学有效率以及不良反应的相关性。采用SPSS 19.0对本研究数据进行处理。结果:替考拉宁在4~100μg·mL^(-1)范围内线性关系良好,标准曲线回归方程为:Y=6 471.14X-2 065.43,R^2=0.999 6,平均日内精密度和日间精密度RSD为3.35%和4.66%,稳定性试验RSD为5.13%。平均提取回收率和方法回收率为82.71%和98.34%。共62例重症肺炎患者纳入本研究,替考拉宁平均稳态谷浓度为(11.98±4.82)μg·mL^(-1),总体临床有效率为64.52%,细菌学有效率为66.13%,7例(11.29%)出现肾功能损伤,4例(6.45%)出现肝功能损伤。质量浓度<10μg·mL^(-1)22例,占35.48%,浓度<15μg·mL^(-1)的45例,占72.58%。Logistic回归分析显示替考拉宁谷浓度与细菌学有效率以及肾毒性分别具有独立相关性,并确定目标谷浓度范围为9~17μg·mL^(-1)。结论:对于重症肺炎患者,为保证临床疗效建议适当增加替考拉宁给药剂量,必要时可开展血药浓度监测,使其有效浓度维持在9~17μg·mL^(-1)范围。OBJECTIVE To evaluate the effective serum concentration range and clinical efficacy of teicoplanin in treatment of patients with severe pneumonia in intensive care unit （ICU）. METHODS In ICU, sixty-two patients with severe pneumonia and receiving teicoplanin treatment were enrolled in a prospective study. The patients received teicoplanin 400 mg for every 12 hours for the first three times, and then received maintenance dose （400 mg） once a day. The steady state trough concentration of teicoplanin serum concentration was monitored by high performance liquid chromatography. The correlation between serum concentration and clinical effective rate, bacteriological efficiency, and adverse reactions were statistically analyzed by SPSS19.0. RESULTS Teicoplanin concentration had good linear relation in the range of 4-100 μg·mL^-1, the regression equation was Y=6 471.14X-2 065.43,R2=0.999 6. The average RSDs of intra and inter day were 3.35% and 4.66%, and the RSD of stability experiment was 5.13%, respectively. The average extraction recovery and method recovery were 82.71% and 98.34%, respectively. The average steady state trough concentration of teicoplanin was 11.98±4.82 μg·mL^-1 in 62 patients, clinical effective rate was 64.52%, and bacteriological efficiency was 66.13%. Seven （11.29%） patients had nephrotoxicity during teicoplanin administration, and four （6.45%） patients had hepatotoxicity. Twenty-two （35.48%） patients had concentrations of teicoplanin lower than 10 μg·mL^-1, and forty-five （72.58%） patients had concentrations lower than 15 μg·mL^-1. The trough concentration of teicoplanin was correlative with bacteriological efficiency and nephrotoxicity. The effective concentration range of teicoplanin was defined as 9-17 μg·mL^-1 by logistic regression analysis. CONCLUSION It is necessary to increase dose of teicoplanin to assure clinical efficacy for patients with severe pneumonia in ICU. Due to rapid changes in clinical conditions of critically ill patients, serum concentrat

关 键 词：替考拉宁 高效液相色谱法 血药浓度 重症肺部感染 

分 类 号：R917[医药卫生—药物分析学]