万古霉素治疗药物监测临床应用分析及完善药学服务探讨  

Analysis of clinical application of therapeutic drug monitoring of vancomycin and improvement of pharmaceutical care

作　　者：李允武[1] 顾方[1] 王婷玉[1] 吴飞华[1] 原永芳[1] LI Yun-wu;GU Fang;WANG Ting-yu;WU Fei-hua;YUAN Yong-fang(Department of Pharmacy,Shanghai Ninth Peopled Hospital,School of Medicine,Shanghai Jiaotong University ,Shanghai 200011,China)

机构地区：[1]上海交通大学医学院附属第九人民医院药剂科,上海200011

出　　处：《实用药物与临床》2018年第12期1406-1410,共5页Practical Pharmacy and Clinical Remedies

摘　　要：目的建立万古霉素血药浓度检测法,并对万古霉素治疗药物监测(TDM)的临床应用进行评价,为药师完善个体化药学服务提供依据。方法对万古霉素HPLC检测的实验条件进行优化,并依据万古霉素治疗药物监测(Therapeutic drug monitoring,TDM)指南和专家共识,对肾脏内科万古霉素的临床用药和TDM应用案例进行分析。结果肾脏内科万古霉素用药患者平均年龄(70. 35±10. 41)岁,60岁以上占92. 86%,75%为CKD 5期肾功能衰竭患者,万古霉素TDM率为35. 71%,但CKD 5期血液透析患者的TDM率仅为10%。结论临床存在血透患者送检比率偏低、采血时间点不合理等问题;药师应充分利用医院HIS系统的功能,及时把握万古霉素用药患者的临床信息,提供契合临床的万古霉素TDM药学服务。Objective To establish a plasma concentration determination method for vancomycin,evaluate the clinical application of therapeutic drug monitoring(TDM)of vancomycin and provide basis for pharmacists to improve individualized pharmaceutical care.Methods The HPLC method for determination of plasma concentrations of vancomycin was optimized,and the drug and TDM cases of vancomycin in department of nephrology were analyzed according to the practice guidelines and expert consensus for TDM of vancomycin.Results The average age of patients with vancomycin medication in department of nephrology was(70.35±10.41)years old,and patients over60years old counting for92.86%,CKD stage5renal failure patients counting for75%.The rate of TDM of vancomycin was35.71%,but the TDM rate of CKD stage5in hemodialysis patients was merely10%.Conclusion There are some problems such as low rate of sampling and unreasonable time point of blood collection in hemodialysis patients.Pharmacists should make full use of the function of HIS system,grasp the clinical information of patients receiving vancomycin in time,and provide pharmaceutical care for vancomycin TDM,which is suitable for clinical use.

关 键 词：万古霉素 治疗药物监测 血药浓度 药学服务 

分 类 号：R969[医药卫生—药理学]