ICU患者万古霉素血药浓度监测及其临床应用  

Determination of serum vancomycin in ICU patients and its clinical application

作　　者：方芳 李宁[2] 徐春丽 杨继红 郑志昌 FANG Fang;LI Ning;XU Chunli;YANG Jihong;ZHENG Zhichang(Department of Pharmaceutics,Affiliated Hospital of Guizhou Medical University,Guiyang 550001,China;National Experimental Teaching Demonstration Center of Pharmacy,China Pharmaceutical University,Nanjing 211198,China)

机构地区：[1]贵州医科大学附属医院药剂科,贵州贵阳550001 [2]中国药科大学,药学国家实验教学示范中心,江苏南京211198

出　　处：《药学研究》2021年第4期272-277,共6页Journal of Pharmaceutical Research

基　　金：贵州省科技计划项目(No.黔科合LH字〔2016〕7255号)。

摘　　要：目的超高效液相测定ICU患者血清中万古霉素,探讨其峰、谷浓度与疗效、安全性的关系。方法血清用10%高氯酸沉淀,梯度洗脱,流动相为乙腈:0.005 mol·L^(-1)磷酸二氢钾缓冲液。结果万古霉素不受内源性物质干扰,线性良好,准确度、回收率、精密度、稳定性均符合要求。峰、谷浓度分别为15.42~89.12、7.30~55.46 mg·L^(-1),谷浓度与肾毒性有弱相关性(相关系数r=0.3772,P<0.05),谷浓度超过24 mg·L^(-1)易发生肾毒性。结论该方法快速、高效,适用于临床血药浓度监测。Objective To develop a rapid ultra-performance liquid chromatographic(UHPLC)method for determination of vancomycin in serum from ICU patients,and investigate the relationship between serum peak-to-valley concentrations of vancomycin and its efficacy and safety.Methods Serum samples were precipitated with 10%perchloric acid,and subsequently analyzed via gradient elution.The mobile phase consisted of acetonitrile and 0.005 mol·L^(-1) KH 2 PO 4 buffer.Results The chromatographic peaks of vancomycin was not interfered by endogenous matrixes.The linearity of vancomycin was satisfactory.The precision,recovery rate,precision and stability of vancomycin all met the requirement of biological samples analysis.In ICU patients,the vancomycin serum peak and trough concentration were 15.42~89.12 mg·L^(-1) and 7.30~55.46 mg·L^(-1),respectively.Spearman correlation analysis showed that there was a weak correlation between serum valley concentration and nephrotoxicity(correlation coefficient r=0.3772,P<0.05).Nephrotoxicity readily occurred when the serum valley concentration exceeded 24 mg·L^(-1).Conclusion The rapid UHPLC method with high efficiency was suitable for the therapeutic drug monitoring(TDM)of vancomycin.

关 键 词：万古霉素 超高效液相色谱法 峰谷浓度 肝肾毒性 

分 类 号：R969[医药卫生—药理学]