基于肾功能指标的动态监测对万古霉素治疗老年患者MRSA肺炎的疗效和安全性评价的影响  

Influence of Dynamic Monitoring based on Renal Function Indicators on Evaluation of Efficacy and Safety of Vancomycin in Elderly Patients with MRSA Pneumonia

作　　者：冯会 FENG Hui(Department of Pharmacy,Pingdingshan Hospital of Traditional Chinese Medicine,Pingdingshan He'nan 467000,China)

机构地区：[1]平顶山市中医医院药剂科,河南平顶山467000

出　　处：《抗感染药学》2021年第4期483-487,共5页Anti-infection Pharmacy

摘　　要：目的:探究基于肾功能指标的动态监测对评估万古霉素治疗老年患者耐甲氧西林金黄色葡萄球菌(MRSA)肺炎的疗效和安全性指标的可行性,为万古霉素药学监护评估其可行性提供参考。方法:选取2017年3月—2020年2月间收治的老年MRSA肺炎患者118例资料,按治疗方法的不同将其分为常规治疗组(n=56)和干预组(n=62),常规治疗组患者采用常规万古霉素治疗,干预组患者则根据内生肌酐清除率(CCR)、血肌酐(Scr)、尿素氮(BUN)动态监测灵活调整万古霉素用量;比较两组患者万古霉素治疗前后CCR、Scr、BUN测得值的变化和万古霉素血清谷浓度的差异,分析其CCR、Scr、BUN测得值变化与万古霉素血清谷浓度的相关性,探究治疗后两组患者的临床疗效和不良反应发生率的差异。结果:通过双因素的方差分析发现,干预组患者Scr、BUN和万古霉素血清谷浓度均显著低于常规治疗组,但CCR值显著高于常规治疗组(P<0.05);通过Pearson相关性分析发现,万古霉素血清谷浓度的高低与CCR(r=-0.473)呈负相关,而与Scr(r=0.537)和BUN(r=0.619)呈正相关(P<0.05);两组患者的万古霉素治疗的总有效率和MRSA清除率经组间比较其差异无统计学意义(P>0.05),但干预组患者不良反应发生率显著低于常规治疗组(P<0.05)。结论:动态监测CCR、Scr、BUN值的变化,可反映万古霉素血药谷浓度治疗窗范围(10~20 mg/L),其对临床预防肾功能损伤以及临床疗效与安全性均具有指导意义。Objective: To explore the feasibility of dynamic monitoring based on renal function indicators for evaluating the efficacy and safety indicators of vancomycin in elderly patients with methicillin-resistant Staphylococcus aureus(MRSA) pneumonia, and to provide reference for the feasibility evaluation of vancomycin in pharmaceutical care.Methods: Data of 118 elderly patients with MRSA pneumonia admitted to our hospital from March 2017 to February2020 were selected. Based on different treatment methods, the patients were divided into conventional treatment group(n=56, conventional vancomycin was used) and intervention group(n=62), that was, the dosage of vancomycin was adjusted base on the dynamic monitoring of endogenous creatinine clearance rate(CCR), serum creatinine(SCR) and urea nitrogen(BUN). The changes of measured values of CCR, SCR, BUN and the difference of serum valley concentration of vancomycin were compared between the two groups before and after treatment, and the correlation between the changes of measured values of CCR, SCR, BUN and serum valley concentration of vancomycin was analyzed, so as to explore the differences of clinical efficacy and incidence of adverse reactions between the two groups after treatment.Results: Two-way ANOVA showed that the serum valley concentrations of Scr, BUN and vancomycin in the intervention group were significantly lower than those in the conventional treatment group, but the CCR value was significantly higher than that in the conventional treatment group(P<0.05). Pearson correlation analysis showed that the serum valley concentration of vancomycin was negatively correlated with CCR(r=-0.473), but positively correlated with SCR(r=0.537) and BUN(r=0.619)(P<0.05). There was no statistical significance in the total effective rate and MRSA clearance rate of vancomycin treatment between the two groups(P>0.05), but the incidence of adverse reactions in the intervention group was significantly lower than that in the conventional treatment group(P<0.05). Conclusion: Dynamic

关 键 词：肾功能 万古霉素 耐甲氧西林的金黄色葡萄球菌 肺炎患者 

分 类 号：R969.3[医药卫生—药理学]