骨科术后患者万古霉素峰谷浓度的影响因素及群体药动学预测比较  

Factors influencing peak and trough vancomycin concentrations in postoperative orthopaedic patients and its comparative population pharmacokinetic prediction

作　　者：杨浩[1,2] 熊雄 刘长江 YANG Hao;XIONG Xiong;LIU Changjiang(Department of Pharmacy,The Sixth Affiliated Hospital of Xinjiang Medical University,Xinjiang Urumqi 830000,China;Department of Pharmacy,Sixth Clinical Medical College,Xinjiang Medical University,Xinjiang Urumqi 830000,China;College of Pharmacy,Xinjiang Medical University,Xinjiang Urumqi 830017,China)

机构地区：[1]新疆医科大学第六附属医院药学部,新疆乌鲁木齐830000 [2]新疆医科大学第六临床医学院药学教研室,新疆乌鲁木齐830000 [3]新疆医科大学药学院,新疆乌鲁木齐830017

出　　处：《中国医院药学杂志》2023年第24期2722-2728,共7页Chinese Journal of Hospital Pharmacy

基　　金：新疆维吾尔自治区药学会科研基金项目(编号:YXH202114)。

摘　　要：目的:分析影响骨科术后患者万古霉素血药峰谷浓度的因素,并探讨预测骨科术后患者万古霉素血药峰谷浓度较好的群体药动学软件。方法:采用直接化学发光技术测定新疆医科大学第六附属医院骨科术后患者万古霉素峰谷血药浓度,收集患者基本信息和用药前的血常规及生化指标,通过二元logistics回归分析万古霉素血药峰谷浓度的影响因素。采用个体化SmartDose、“万古霉素剂量推荐和血药浓度预测工具”、Vancomycin Calculator和Vancomycin Calculator+JPKD 4种群体药动学软件对骨科术后患者万古霉素血药峰谷浓度进行预测,并采用绝对权重偏差判断适用于预测骨科术后患者万古霉素血药峰谷浓度的软件。结果:纳入82名患者,发现肌酐清除率和胱抑素C分别在峰和谷浓度各组间存在差异(P<0.05)。二元logistics回归分析发现:胱抑素C是万古霉素峰谷浓度的独立保护因素(OR=28.482,OR=62.691,均为P<0.05)。Vancomycin Calculator+JPKD预测的骨科术后患者万古霉素血药峰谷浓度的绝对权重偏差均小于30%。结论:胱抑素C水平可能是影响骨科术后患者万古霉素峰谷浓度的重要参数,Vancomycin Calculator+JPKD在骨科术后患者中预测万古霉素峰谷浓度较好。OBJECTIVE To analyze the factors that affect the peak to valley concentration of vancomycin blood in patients after orthopedic surgery,and to explore a population pharmacokinetic software that can predict the peak to valley concentration of vancomycin blood in patients after orthopedic surgery.METHODS Direct chemiluminescence technology was used to determine vancomycin peak and trough blood concentrations in postoperative orthopedic patients in The Sixth Affiliated Hospital of Xinjiang Medical University.Basic information of patients and routine blood and biochemical indexes before drug administration were collected,and the influencing factors of vancomycin blood peak and trough concentrations were analyzed by binary logistics regression.four population pharmacokinetics software,SmartDose,Vancomycin dose recommendation and blood concentration prediction tool,Vancomycin Calculator and Vancomycin Calculator+JPKD,were used to predict vancomycin blood peak and trough concentrations in postoperative orthopedic patients,and absolute weight deviation was used to determine the software applicable to predict vancomycin blood peak and trough concentrations in postoperative orthopedic patients.RESULTS Eighty-two patients were included in this study and creatinine clearance and cystatin C were found to differ between the groups for peak and trough concentrations,respectively(P<0.05).Binary logistics regression analysis revealed that cystatin C was an independent protective factor for vancomycin peak and trough concentrations(OR=28.482 and OR=62.691,both P<0.05).The absolute weight deviation of Vancomycin Calculator+JPKD predicted vancomycin blood peak and trough concentrations in post-operative orthopedic patients were<30%.CONCLUSION Cystatin C levels may be an important parameter affecting vancomycin peak and trough concentrations in post-operative orthopedic patients,and Vancomycin Calculator+JPKD predicts vancomycin peak and trough concentrations better in post-operative orthopedic patients.

关 键 词：骨科 万古霉素 峰浓度 谷浓度 群体药动学 

分 类 号：R969.1[医药卫生—药理学]