神经外科重症患者万古霉素血清谷浓度影响因素分析  

Analysis of influencing factors of trough serum vancomycin concentrations in critically ill neurosurgical patients

作　　者：姚明丽 李静超[1] 石磊[1] 王玉芳[1] 王凌雁[1] 管向东[1] 欧阳彬[1] Yao Mingli;Li Jingchao;Shi Lei;Wang Yufang;Wang Lingyan;Guan Xiangdong;Ouyang Bin(Department of Critical Care Medicine,the First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,Guangdong,China)

机构地区：[1]中山大学附属第一医院重症医学科,广东广州510080

出　　处：《中华危重病急救医学》2019年第11期1384-1388,共5页Chinese Critical Care Medicine

基　　金：国家临床重点专科建设项目(2011-872)。

摘　　要：目的探讨神经外科重症患者万古霉素血清谷浓度及其影响因素。方法采用回顾性研究方法,选择2017年11月至2019年7月在中山大学附属第一医院重症医学科神经外科ICU住院接受万古霉素静脉治疗并行万古霉素血清谷浓度监测的成人患者。记录患者性别、年龄、基础疾病等一般资料以及万古霉素血清谷浓度、万古霉素用量及疗程、尿量、血肌酐(SCr)和联合用药(包括甘露醇、利尿剂、血管活性药物、非甾体抗炎药、多黏菌素、氨基糖苷类药物和造影剂等);分析神经外科重症患者万古霉素血清谷浓度特征,采用多重线性回归法分析其影响因素。结果共纳入28例患者,监测万古霉素血清谷浓度81例次。①万古霉素初始用量为2.00(2.00,2.00)g/d,给药4~6次后,首次万古霉素血清谷浓度为10.99(6.98,16.25)mg/L;治疗初始仅有17.9%(5/28)的患者达目标浓度(15~20 mg/L),71.4%(20/28)低于目标浓度,10.7%(3/28)超过目标浓度。②万古霉素疗程为8.0(6.0,15.0)d,万古霉素用量2.00(1.75,3.00)g/d;治疗期间万古霉素血清谷浓度达目标浓度者仅占30.9%(25/81),低于目标浓度者占49.4%(40/81),超过目标浓度者占19.7%(16/81)。③治疗期间不同万古霉素血清谷浓度各组患者间年龄、基础疾病、万古霉素用量、使用利尿剂、甘露醇用量等指标比较差异均有统计学意义;多重线性回归分析结果显示,年龄每增加1岁,万古霉素血清谷浓度增加0.14 mg/L〔95%可信区间(95%CI)为0.06~0.22〕;同时患有高血压、糖尿病和冠心病者较无基础疾病者万古霉素血清谷浓度增加7.22 mg/L(95%CI为2.08~12.36);使用利尿剂者较不使用利尿剂者万古霉素血清谷浓度增加2.78 mg/L(95%CI为0.20~5.35);其余自变量的影响不具有统计学意义。说明年龄、有无多种基础疾病(合并高血压、糖尿病和冠心病)、是否使用利尿剂是万古霉素血清谷浓度的影响因素。结论神经外科重症�Objective To evaluate trough serum vancomycin concentrations and identify their influencing factors in critically ill neurosurgical patients.Methods A retrospective study was conducted.Adult patients who received vancomycin with at least one appropriate monitoring of trough serum vancomycin concentration and admitted to neurosurgical intensive care unit(ICU)of the First Affiliated Hospital of Sun Yat-sen University from November 2017 to July 2019 were enrolled.General information including gender,age,comorbidities,etc.,trough serum vancomycin concentrations,vancomycin dosage,duration of vancomycin therapy,urine output,serum creatinine(SCr),concurrent medications(including mannitol,diuretic,vasopressors,non-steroidal anti-inflammatory drugs,polymyxin,aminoglycosides and contrast medium,etc.)were collected for analysis.Trough serum vancomycin concentrations were evaluated and their influencing factors were analyzed by multiple linear regression method.Results In total,81 trough serum vancomycin concentration data sets obtained from 28 patients were evaluated.①The initial daily dose of vancomycin was 2.00(2.00,2.00)g/d.After 4-6 doses,the trough serum vancomycin concentration obtained from initial blood draw was 10.99(6.98,16.25)mg/L,of which only 17.9%(5/28)achieving targeted concentrations(15-20 mg/L),71.4%(20/28)subtherapeutic level and 10.7%(3/28)supratherapeutic level.②The duration of vancomycin therapy was 8.0(6.0,15.0)days.With average daily dose of 2.00(1.75,3.00)g/d,targeted trough vancomycin concentrations were achieved in only 30.9%(25/81)of all cases,subtherapeutic concentrations in 49.4%(40/81)and supratherapeutic concentrations in 19.7%(16/81).③There were significant differences in age,comorbidities,vancomycin dosage,diuretics use and mannitol dosage,etc.among different vancomycin concentration groups.Multiple linear regression analysis suggested that the trough serum vancomycin concentration increased by 0.14 mg/L[95%confidence interval(95%CI)was 0.06-0.22]for every 1 year increase in age,increa

关 键 词：万古霉素 治疗 血清谷浓度 血药浓度监测 

分 类 号：R[医药卫生]