某三甲医院万古霉素血药浓度监测回顾性分析及合理用药评价  

Therapeutic drug monitoring and evaluation of vancomycin use in a tertiary hospital

作　　者：张文渊 潘惠萍[1] 黎颖然[1] 刘峰[1] 刘锐锋[1] ZHANG Wen-yuan;PAN Hui-ping;LI Ying-ran;LIU Feng;LIU Rui-feng(Department of Pharmacy,Zhongshan People’s Hospital,Zhongshan Guangdong 528403)

机构地区：[1]广东省中山市人民医院药学部,广东中山528403

出　　处：《中南药学》2020年第8期1414-1417,共4页Central South Pharmacy

基　　金：中山市社会公益科技研究项目(No.2019B1076)。

摘　　要：目的分析本院万古霉素血药浓度监测及合理用药情况,为临床药学工作持续改进提供参考。方法回顾性分析2017-2019年108位患者万古霉素血药浓度监测报告177例次,对患者的一般资料及万古霉素对其肾功能影响的相关因素进行统计分析,并评估万古霉素应用的合理性。结果 7.4%的患者存在万古霉素剂量或者药物选择方面的不合理。万古霉素平均使用(5.3±4.1)d后首次送检,且仅有35.6%例次的谷浓度介于参考值范围。万古霉素危急值(谷浓度>25 μg·mL-1)患者肾功能损害发生率显著高于未达危急值患者(32.6% vs 10.0%,P<0.01)。危急值患者的肌酐清除率下降有统计学意义,万古霉素使用前为16.3(6.9,42.7)mL·min-1,使用后为15.5(7.5,25.9)mL·min-1(P<0.05)。使用群体药代动力学工具(https://clincalc.com/Vancomycin/)预测万古霉素危急值患者谷浓度,42.1%的患者预测值与实测值偏差小于20%。结论万古霉素及时检测以及危急值的报告对保障患者用药安全有重要意义。利用群体药代动力学工具优化初始给药方案有望改善患者的谷浓度达标率。Objective To analyze the therapeutic drug monitoring (TDM) data and rational use of vancomycin in a tertiary hospital.Methods A total of 108 patients and 177 reports of vancomycin-TDM from 2017 to 2019 were collected.General data of the patients and the influence of vancomycin on their renal function were analyzed.The rationality of vancomycin use was evaluated.Results 7.4% of the patients had irrational vancomycin dosage or drug selection.After the average use of vancomycin for (5.3±4.1) d,the serum was firstly sent for TDM.Only 35.6% cases of trough concentration were within the reference range.The incidence of nephrotoxicity in patients with vancomycin critical value (trough concentration>25 μg·mL-1) was significantly higher than that in patients without critical value (32.6% vs 10.0%,P<0.01).Furthermore,the decrease of creatinine clearance rate in patients with critical value was significant[before vancomycin use:16.3 (6.9,42.7) mL·min-1,after vancomycin use:15.5 (7.5,25.9) mL·min-1,P<0.05].The vancomycin trough concentration was predicted with the population pharmacokinetics website (https://clincalc.com/vancomycin/).42.1% of the patients had a deviation of less than 20% between the predicted value and the measured value.Conclusion Timely detection of vancomycin and report of critical value are important in ensuring the safety of drug use.Population pharmacokinetics tools are expected to help improve the reaching ratio of vancomycin.

关 键 词：临床药师 血药浓度监测 合理用药 万古霉素 危急值 

分 类 号：R96[医药卫生—药理学]