重症患者肾功能亢进对替考拉宁血药浓度影响分析  

Influence of argumented renal clearance on teicoplannin serum concentrations in critical ill patients

作　　者：汪飞 杭永付[1] 王未 WANG Fei;HANG Yongfu;WANG Wei(Department of Pharmacy,the First Affiliated Hospital of Soochow University,Suzhou 215000,Jiangsu,China)

机构地区：[1]苏州大学附属第一医院药学部,苏州215000

出　　处：《中国临床药理学与治疗学》2023年第9期1043-1048,共6页Chinese Journal of Clinical Pharmacology and Therapeutics

基　　金：国家自然科学青年基金(82003842)。

摘　　要：目的:分析本院替考拉宁使用重症人群及使用后血药浓度监测情况,通过对比肾功能亢进与非亢进重症患者使用替考拉宁后血药浓度监测结果,为高肾清除率重症患者临床合理用药提供参考。方法:回顾性分析2019年8月至2021年3月期间入住某三甲医院重症医学科64例病人替考拉宁血药浓度,对替考拉宁的监测结果、用药信息和其他生化指标进行统计分析。结果:64例重症加强护理病房(ICU)病人共监测血药浓度110例次,血药浓度平均值13.6 mg/L。近半数监测例次患者替考拉宁血药浓度不达标。32.7%的患者出现肾功能亢进,对于非肾功能亢进患者,增加替考拉宁维持剂量可显著提高血药浓度;对于肾功能亢进患者,替考拉宁血药浓度在不同维持剂量给药组无明显差异。进一步相关性研究发现,肾功能亢进患者替考拉宁血药浓度与血清胱抑素C水平呈显著正相关,与白蛋白水平显著负相关。结论:ICU患者肾功能亢进发生率高,使用替考拉宁维持剂量600 mg可能对于严重感染效果欠佳,需结合血药浓度监测并进一步提高给药剂量以提高药效。AIM:By analyzing the teicoplannin serum concentration in patients with severe infection and comparing the monitoring results in patients with hyperrenal function and non-hyperrenal function,to provide reference for clinical rational drug use.METHODS:A retrospective analysis was conducted on 64 patients admitted to the department of critical care medicine of a tertiary level hospital from August 2019 to March 2021,and statistical analysis was performed on the monitoring results of teicoplannin,together with medication information and other biochemical indicators of these patients.RESULTS:Sixty-four patients had total 110 times of drug monitoring.32.7%of ICU patients had renal hyperfunction,and the average serum concentration was 13.6 mg/L.Nearly half of blood concentrations of the monitored patients could not reach the therapeutic target of teicoplanin.For patients without argumented real clearance,increasing the maintenance dose of teicoplanin can significantly increase the blood concentration.While for those with argumented real clearance,the blood concentration of teicoplanin had no significant difference in different maintenance dose groups.Further correlation study found that the serum concentration of teicoplanin in patients with argumented real clearance was significantly positively correlated to cystatin C level,and significantly negatively correlated to albumin level.CONCLUSION:The incidence of renal hyperfunction in ICU patients is high,and the maintenance dose of teicoplanin 600 mg may not be effective for severe infection.To improve the effect of teicoplanin in severe patients,the drug concentration should be monitored to adjust the dose.

关 键 词：替考拉宁 药物浓度监测 肾功能亢进 

分 类 号：R978.1[医药卫生—药品] R969.1[医药卫生—药学]