重症患者持续与间歇输注万古霉素血药浓度监测结果分析  

Therapeutic drug monitoring after continuous and intermittent infusion of vancomycin in critically ill patients

作　　者：黎命娟 鹿中华[1] 杨翔[1] 曹利军[1] 孙昀[1] LI Mingjuan;LU Zhonghua;YANG Xiang;CAO Lijun;SUN Yun(Division,Department of Critical Care Medicine,the Second Affiliated Hospital of Anhui Medical University,Hefei 230000,China)

机构地区：[1]安徽医科大学第二附属医院重症医学一科,合肥230000

出　　处：《中国感染与化疗杂志》2022年第3期277-281,共5页Chinese Journal of Infection and Chemotherapy

摘　　要：目的监测及分析持续与间歇输注万古霉素血药浓度达标情况及临床结局的差异,探索适合万古霉素的输注方式。方法回顾性分析2018年10月—2021年5月安徽医科大学第二附属医院ICU危重症患者持续和间歇输注万古霉素后监测血药浓度结果,分析两种输注方式血药浓度达标情况和临床结局。结果监测持续输注与间歇输注万古霉素血药浓度[(17.3±4.8)mg/L对(9.4±4.9)mg/L,P<0.01]差异存在统计学意义,持续输注组血药浓度显著高于间歇输注组,各自目标浓度达标率分别为59.4%和40.9%,间歇输注组达到重症感染目标谷浓度(15~20 mg/L)的比例仅为9.1%,而两组间临床结局及微生物学结局差异无统计学意义。肌酐清除率与间歇输注组万古霉素血药浓度存在相关性,而与持续输注组血药浓度相关性不显著。血药浓度≥15 mg/L时,间歇输注组肾毒性发生率显著高于持续输注组。结论持续输注万古霉素可显著提高万古霉素治疗浓度,两种输注方式患者的临床结局及微生物学结局差异无统计学意义。肌酐清除率可影响万古霉素间歇输注时血药浓度监测结果。万古霉素血药浓度高于15 mg/L时,应注意监测间歇输注组患者肾功能。Objective To monitor and analyze the blood concentration of vancomycin and clinical outcomes after continuous and intermittent infusion of vancomycin in critically ill patients.Methods A retrospective analysis was conducted with the results of blood drug concentration after continuous and intermittent infusion of vancomycin in the critically ill patients treated in the ICU from October 2018 to May 2021.The results of compliance and clinical outcome were summarized accordingly.Results The blood vancomycin concentration was significantly different after administration by continuous versus intermittent infusion[(17.3±4.8)vs(9.4±4.9)mg/L,P<0.01].Continuous infusion resulted in significantly higher blood concentration than intermittent infusion.The compliance rate was 59.4%and 40.9%,respectively.The target trough concentration for severe infection(15-20 mg/L)was reached in only 9.1%of the patients after intermittent infusion.The clinical and microbiological outcomes did not show significant difference between the two modes of administration.The creatinine clearance rate was only significantly correlated with the blood concentration of vancomycin after intermittent infusion.When blood vancomycin concentration≥15 mg/L,intermittent infusion was associated with significantly higher incidence of nephrotoxicity than continuous infusion.Conclusions Continuous infusion of vancomycin can significantly increase the therapeutic concentration.Continuous and intermittent infusion of vancomycin did not result in significant difference in clinical and microbiological outcomes.Creatinine clearance rate may affect the blood concentration after intermittent infusion.The renal function must be closely monitored when the blood vancomycin concentration is higher than 15 mg/L after intermittent infusion.

关 键 词：万古霉素 持续输注 间歇输注 血药浓度 肾功能 

分 类 号：R978.15[医药卫生—药品]