重症感染患者万古霉素不同给药方式血药浓度影响因素分析  

Analysis of Influencing Factors of Vancomycin Plasma Concentration in Patients with Severe Infection by Different Administration Methods

作　　者：刘云宁[1] 李小风 汤建华[1] 姜爱雯[1] 胡亚丽[1] 马琴琴[1] LIU Yunning;LI Xiaofeng;TANG Jianhua;JIANG Aiwen;HU Yali;MA Qinqin(The First Affiliated Hospital of Hebei North University,Zhangjiakou,Hebei,China 075000)

机构地区：[1]河北北方学院附属第一医院,河北张家口075000

出　　处：《中国药业》2023年第16期100-103,共4页China Pharmaceuticals

基　　金：河北省医学科学研究课题计划[20211198]。

摘　　要：目的探讨不同给药方式下重症感染患者万古霉素血药浓度的影响因素。方法回顾性分析医院重症医学科2020年2月至2021年2月收治的96例予万古霉素连续静脉注射(CIV,45例)或间歇静脉注射(IIV,51例)治疗的重症感染患者的临床资料,采用简单线性与多重线性回归分析2种给药方式下重症感染患者万古霉素血药浓度的影响因素。结果CIV患者的血药浓度达标率为73.33%,明显高于IIV患者的49.02%(P<0.05)。简单线性回归分析显示,白蛋白水平、肌酐清除率、首日体质量剂量及年龄、中重度水肿、白蛋白水平、肌酐清除率、首日体质量剂量分别为CIV及IIV患者万古霉素血药浓度的影响因素;多重线性回归分析结果显示,肌酐清除率、首日体质量剂量及肌酐清除率、中重度水肿、首日体质量剂量、白蛋白水平分别为CIV及IIV患者万古霉素血药浓度的独立影响因素。结论对需使用万古霉素的重症感染患者,CIV相较IIV更易达到有效浓度,独立影响因素(首日体质量剂量、肌酐清除率)更少,且可通过肾功能支持和调整首日给药剂量优化万古霉素的个体化给药方案。Objective To investigate the influencing factors of vancomycin plasma concentration in patients with severe infection by different administration methods.Methods The clinical data of 96 patients with severe infection admitted to the Department of Critical Care Medicine in the hospital from February 2020 to February 2021 were retrospectively analyzed.Among them,45 cases were given the continuous intravenous injection(CIV)of vancomycin,while 51 cases were given the intermittent intravenous injection(IIV)of vancomycin.Simple linear and multiple linear regression analysis were performed to investigate the influencing factors of vancomycin plasma concentration in patients with severe infection by two administration methods.Results The standard-reaching rate of plasma concentration in CIV patients was 73.33%,which was significantly higher than 49.02%in IIV patients(P<0.05).The simple linear regression analysis showed that albumin level,creatinine clearance rate(CCR)and first-day dose/body mass were the influencing factors of vancomycin plasma concentration in CIV patients,while age,moderate and severe edema,albumin level,CCR and first-day dose/body mass were the influencing factors in IIV patients.The multiple linear regression analysis showed that CCR and first-day dose/body mass were the independent influencing factors of vancomycin plasma concentration in CIV patients,while CCR,moderate and severe edema,first-day dose/body mass and albumin level were the independent influencing factors in IIV patients.Conclusion For patients with severe infection needing to use vancomycin,CIV is easier to reach the effective plasma concentration than IIV,and vancomycin plasma concentration CIV patients had fewer independent influencing factors(first-day dose/body mass and CCR).Moreover,the individualized administration scheme of vancomycin can be optimized by giving renal function support and adjusting first-day dose in CIV patients.

关 键 词：重症感染 万古霉素 连续静脉注射 间歇静脉注射 血药浓度 影响因素 回归分析 

分 类 号：R969.3[医药卫生—药理学]