重症患者使用维持剂量后替考拉宁血药谷浓度明显升高的相关因素分析  

Analysis of factors associated with markedly elevated trough serum concentrations of teicoplanin after maintenance doses in critically ill patients

作　　者：徐吟秋 王晶[1,2] 申越 朱建柱 梁培 XU Yinqiu;WANG Jing;SHEN Yue;ZHU Jianzhu;LIANG Pei(Department of Pharmacy,Affiliated Nanjing Drum Tower Hospital,School of Medicine,Nanjing University,Jiangsu Nanjing 210008,China;Nanjing Medical Center for Clinical Pharmacy,Jiangsu Nanjing 210008,China;Department of Pharmacy,Nanjing Drum Tower Hospital,China Pharmaceutical University,Jiangsu Nanjing 210008,China;Department of Pharmacy,Nanjing Drum Tower Hospital,College of Medicine,Nanjing University of Chinese Medicine,Jiangsu Nanjing 210029,China)

机构地区：[1]南京大学医学院附属鼓楼医院药学部,江苏南京210008 [2]南京临床药学中心,江苏南京210008 [3]中国药科大学南京鼓楼医院药学部,江苏南京210008 [4]南京中医药大学鼓楼临床医学院药学部,江苏南京210029

出　　处：《中国医院药学杂志》2024年第10期1174-1178,共5页Chinese Journal of Hospital Pharmacy

基　　金：南京药学会—常州四药医院药学科研基金资助课题(编号:2022YX006);南京鼓楼医院药学部科研专项(No.24)。

摘　　要：目的:探索重症患者使用维持剂量后替考拉宁血药谷浓度升高的相关因素,为替考拉宁的治疗药物监测提供参考。方法:收集南京大学医学院附属鼓楼医院重症监护室2021年2月至2023年2月使用替考拉宁患者的基本特征、生化指标、血药浓度等信息,同时测定患者使用维持剂量前后替考拉宁血药谷浓度,分析使用维持剂量后替考拉宁血药谷浓度的变化,依据变化情况将患者分为浓度明显升高组与未明显升高组,并展开单因素分析与logistic回归。结果:41例纳入患者中,使用维持剂量后替考拉宁谷第2次监测浓度较第1次显著升高[(27.5±11.0)mg·L^(–1)vs.(17.3±6.70)mg·L^(–1),P<0.01],平均升高10.2 mg·L^(–1),其中18例血药浓度升高值≥10.2 mg·L^(–1)的被划分为明显升高组,23例血药浓度升高值<10.2 mg·L^(–1)的被划分为未明显升高组。单因素分析显示,患者首次用药至第2次监测血药浓度期间白蛋白最大值、白蛋白最大值与最小值之差、采用连续肾脏替代治疗是替考拉宁血药浓度明显升高的危险因素(P<0.05),而logistic回归显示其中白蛋白最大值与最小值之差是独立危险因素。结论:替考拉宁在使用维持剂量后需要密切关注患者白蛋白变化情况,并及时重复监测以提高患者用药安全性。OBJECTIVE To explore the factors associated with an elevation of trough serum concentration of teicoplanin in critically ill patients after maintenance dose and provide references for its therapeutic monitoring.METHODS From February 2021 to February 2023,basic profiles,biochemical parameters and serum concentrations of teicoplanin were retrospectively reviewed for 41 patients hospitalized in intensive care unit of Nanjing Drum Tower Hospital.Trough serum teicoplanin concentrations were collected before and after maintenance doses.The changes of trough serum concentration of teicoplanin after maintenance dose were recorded.They were assigned into two groups of marked elevation(n=18,≥10.2 mg·L^(–1))and non-marked elevation(n=23,<10.2 mg·L^(–1)).Univariate and Logistic regression analyses were performed.RESULTS Among them,the second monitoring after maintenance dose spiked markedly[(27.5±11.0)vs.(17.3±6.70)mg·L^(–1),P<0.01]than the first monitoring before maintenance dose with a mean rise of 10.2 mg·L^(–1).Univariate analysis revealed that maximal albumin,difference between maximal albumin and minimal albumin and continuous renal replacement therapy between the first dose and the second concentration monitoring were risk factors for a marked elevation of teicoplanin(P<0.05).Logistic regression revealed that difference between maximal albumin and minimal albumin was an independent risk factor.CONCLUSION Close monitoring of albumin changes is required after a maintenance dose of teicoplanin.Timely concentration monitoring of teicoplanin helps to improve its dosing safety.

关 键 词：替考拉宁 重症患者 维持剂量 血药谷浓度 影响因素 

分 类 号：R969.3[医药卫生—药理学]