万古霉素在重症感染患者的药动学  

Pharmacokinetics of Vancomycin in Patients with Severe Sepsis

作　　者：黄兴富[1] 童伟[2] 吴静 陈虹[4] 黄洁[5] 方洁[6] HUANG Xingfu;TONG Wei;WU Jing;CHEN Hong;HUANG Jie;FANG Jie(Department of Pharmacy, the First People＇s Hospital of Qujing City, Yunnan Province, Qujing 655000, China;Department of Pharmacy, Jiangxi Cancer Hospital, Nanchang 330029, China;Department of Pharmacy, Hangzhou Obstetrics and Gynecology Hospital, Hangzhou 310008, China;Department of Respiratory Medicine, Ruijin Hospital Affiliated to School of Medicine, Shanghai Jiaotong University, Shanghai 200025, China;Department of SICU, Ruijin Hospital Affiliated to School of Medicine, Shanghai Jiaotong University, Shanghai 200025, China;Department of Pharmacy, Ru, ijin Hospital Affiliated to School of Medicine, Shanghai Jiaotong University, Shanghai 200025, China)

机构地区：[1]云南省曲靖市第一人民医院药剂科,曲靖655000 [2]江西省肿瘤医院药剂科,南昌330029 [3]杭州市妇产科医院药剂科,杭州310008 [4]上海交通大学医学院附属瑞金医院呼吸科,上海200025 [5]上海交通大学医学院附属瑞金医院重症医学科,上海200025 [6]上海交通大学医学院附属瑞金医院药剂科,上海200025

出　　处：《医药导报》2018年第6期745-749,共5页Herald of Medicine

摘　　要：目的研究万古霉素在重症感染患者体内的血药谷浓度和药动学特点。方法收集重症感染且使用万古霉素进行治疗的患者128例,根据感染部位分为肺部感染组(n=45)、腹腔感染组(n=37)、血流感染组(n=33)和混合感染组(n=13);根据年龄分为老年人组(≥65岁)54例和成年人组(18~<65岁)74例,采用荧光偏振免疫法测定其血药谷浓度值,利用贝叶斯反馈法计算其万古霉素药动学参数。结果血药谷浓度值个体差异大(1.7~36.8 mg·L-1),仅46.9%患者血药谷浓度在目标血药谷浓度(10~20 mg·L-1)范围内,其中成年人组达标率为43.2%,老年人组达标率为51.9%,老年人组平均血药谷浓度值高于成年人组。回归分析显示,万古霉素血药谷浓度与患者年龄、肌酐清除率和急性生理与慢性健康评分相关。万古霉素的表观分布容积为(1.00±0.12)L·kg-1,清除率为(78.80±44.51)m L·min-1,表观分布容积较万古霉素平均表观分布容积显著增大,且成年人组清除率明显高于老年人组。结论重症感染患者万古霉素血药谷浓度达标率低,血药谷浓度和药动学参数的个体差异都非常明显,患者年龄、肌酐清除率和急性生理与慢性健康评分对血药谷浓度影响较大。临床使用万古霉素时,应根据患者自身的病理生理状况,借助治疗血药浓度监测来优化万古霉素的给药方案,实施个体化用药。Objective To investigate the serum trough concentration and pharmacokinetics of vancomycin in patients with severe sepsis. Methods Trough concentrations of vancomycin from 128 patients with severe sepsis were collected. All eligible patients were divided into lung infection group（n = 45）,abdominal infection group（n = 37）,bloodstream infection group（n= 33） and mixed infection group（n= 13） according to the different infection site. According to the age,patients were divided into elderly group（n = 54） and adult group（n = 74）. The trough concentration of vancomycin was measured by fluorescence polarization immunoassay. The pharmacokinetic parameters of vancomycin were calculated by Bayesian feedback method.Results The trough concentrations of vancomycin varied from 1.7 to 36.8 mg·L-1. Only 46.9%of the samples could reach 10-20 mg·L-1. The standard-reaching rate in adult group was 43. 2%,that of elderly group was 51. 9%. The mean vancomycin trough concentration of the elderly was higher than that of the adults. Regression analysis indicated that vancomycin trough concentrations had a good correlation with age,creatinine clearance,acute physiology and chronic health score. The Vdof vancomycin was（1.00±0.12） L·kg-1,and the CL was（78.80±44.51） m L·min-1,significantly increased（P〈0.01）. The Vd increased significantly,which is compared with the mean Vdof vancomycin,and the CL of the adult group was significantly higher than that of the elderly group. Conclusion The stand reaching rate of vancomycin serum trough concentration is low in patients with severe sepsis. Both the trough concentration and pharmacokinetic parameters had significant individual differences. The age,CL and APACHE Ⅱ of the patients obviously influenced the trough concentration. Vancomycin should be used based on the patient＇s own pathophysiological conditions,the dosing regimen could be optimized with the help of therapeutic drug mornitoring,and clinical individualization should be implemented.

关 键 词：万古霉素 感染 重症 血药谷浓度 药动学 

分 类 号：R978.1[医药卫生—药品] R969.1[医药卫生—药学]