基于循证指南评价某院万古霉素治疗药物监测现状  

Evaluation on Status of Therapeutic Drug Monitoring of Vancomycinin in a Hospital Based on Evidence-based Guideline

作　　者：黄冰琳 何馨 郭锦华[1] 程昱[1] 郑斌[1] 刘茂柏[1] HUANG Bing-lin;HE Xin;GUO Jin-hua;CHENG Yu;ZHENG Bin;LIU Mao-bai(Department of pharmacy,Fujian Medical University Union Hospital,Fuzhou 350001,China;College of Pharmacy,Fujian Medical University,Fuzhou 350004,China)

机构地区：[1]福建医科大学附属协和医院药学部,福建福州350001 [2]福建医科大学药学院,福建福州350004

出　　处：《海峡药学》2021年第11期96-100,共5页Strait Pharmaceutical Journal

基　　金：福建省自然科学基金(项目编号:2021J01783)。

摘　　要：目的调查某院万古霉素治疗药物监测(Therapeutic Drug Monitoring,TDM)现状,提出完善药学服务的策略。方法将某院945例使用万古霉素的住院患者分为TDM组和对照组,统计两组患者的血药浓度监测情况,基于2015版中国万古霉素TDM指南进行现状分析。结果283例患者进行TDM,监测率29.9%,共监测470次,人均1.6次,117例患者根据指南调整或维持剂量。首次监测抽血时间符合指南推荐例数为67例,首次监测血药浓度在10~15 mg·L^(-1)的例数为48例。未进行TDM的662例患者中,有319例属于指南推荐监测的人群。结论TDM现状与指南推荐尚有差距,存在应当监测的患者送检率偏低,取血时间不适宜,未及时根据监测结果调整用药方案的现象。临床药师须契合临床需求,基于TDM实施个体化用药的药学服务,提高TDM水平。OBJECTIVE To analyze the situation of therapeutic drug monitoring of vancomycin,so to put forward strategies to improve clinical pharmacy service.METHODS 945 patients treated with vancomycin in a hospital were divided into TDM group or control group according to whether they were conducted TDM.The monitoring status of drug concentration in the two groups was analyzed and evaluated based on evidence-based guideline.RESULTS 283 patients were conducted TDM 470 times,the monitoring rate was 29.9%,1.6 times per patient.117 patients underwent dose adjustment.662 patients were not monitored,in which 319 of them should receive TDM as recommended by guideline.67 cases fulfilled the recommended first blood drawing time by the guidelines,and in 48 cases the blood concentration was within the range of 10-15 mg·L^(-1).CONCLUSION There was a discrepancy between the monitoring situation of vancomycin TDM and the guideline recommendations,including the low testing rate of patients who should be monitored,the inappropriate monitoring time of blood collection,and the failure to adjust the dose timely according to the monitoring results.Clinical pharmacists should justify the clinical needs and implement the clinical pharmacy service of individualized medication for patients based on TDM.

关 键 词：万古霉素 治疗药物监测 循证指南 

分 类 号：R969.1[医药卫生—药理学]