重症监护室感染患者去甲万古霉素谷浓度的达标情况及其影响因素  

Compliance of and factors affecting target attainment of serum trough concentration of norvancomycin in ICU patients

作　　者：徐芳媛 朱忠华[2] 庄仲侠[2] 李超 郑绍鹏[1] XU Fangyuan;ZHU ZhongHua;ZHUANG Zhongxia;LI Chao;ZHENG Shaopeng(Department of Critical Care Medicine,Huangshan People's Hospital,Huangshan Anhui 245000,China)

机构地区：[1]黄山市人民医院重症医学科,安徽黄山245000 [2]黄山市人民医院药剂科,安徽黄山245000

出　　处：《中国感染与化疗杂志》2024年第4期384-389,共6页Chinese Journal of Infection and Chemotherapy

摘　　要：目的探讨去甲万古霉素谷浓度在重症监护室(ICU)患者中的达标情况,不同谷浓度对临床疗效、肾功能损伤的影响,以及影响谷浓度的因素。方法纳入2020年1月至2022年12月入住黄山市人民医院综合ICU并静脉滴注去甲万古霉素的成年患者。记录患者去甲万古霉素的用药方案、稳态下的谷浓度,比较不同谷浓度分组间临床疗效、肾功能损伤的情况,观察不同肾功能状态患者谷浓度达标情况。用logistic回归分析稳态谷浓度的影响因素。结果纳入患者97例,仅33.0%(32/97)达到目标谷浓度(10~20 mg/L),51.5%(50/97)低于目标谷浓度,15.5%(15/97)高于目标谷浓度。谷浓度不同的三组,临床治愈率和肾功能损伤发生率存在差异(P<0.05)。不同肾功能状态的患者谷浓度达标情况存在差异,肾功能亢进及正常者,以低于目标浓度为主,随着肾功能障碍加重高于目标浓度的比例呈升高趋势(P<0.05)。单因素分析显示每日剂量、年龄、性别、身高、体重、体重指数(BMI)、急性生理与慢性健康状况评价Ⅱ(APACHEⅡ)评分、序贯器官衰竭评价(SOFA)评分、血肌酐、尿素氮、降钙素原、是否合并感染性休克及是否使用去甲肾上腺素均与去甲万古霉素的谷浓度显著相关(P<0.05)。多因素logistic回归分析提示年龄、SOFA评分、血尿素氮、性别及是否使用去甲肾上腺素是去甲万古霉素谷浓度的独立影响因素(P<0.05)。结论ICU患者不同肾功能状态下去甲万古霉素的稳态谷浓度较难达到目标,且以谷浓度偏低更多见,临床治愈率低,而谷浓度的升高,肾功能损伤发生率升高。年龄、性别、SOFA评分、血尿素氮水平及使用去甲肾上腺素是去甲万古霉素谷浓度的独立影响因子。Objective To examine the compliance of and factors affecting target attainment of serum trough concentration of norvancomycin in ICU patients,and the effects of different trough concentrations on clinical efficacy and renal impairment.Methods Adult patients admitted to the Department of Critical Care Medicine of Huangshan People’s Hospital and receiving intravenous infusion of norvancomycin from January 2020 to December 2022 were included.The dosing regimens and steadystate trough concentrations of norvancomycin were analyzed.The clinical efficacy and renal impairment were compared between different trough concentration levels.The compliance of trough concentration in critically ill patients with different renal functions was examined.Logistic regression analysis was performed to profile the factors possibly affecting the trough concentration of norvancomycin.Results A total of 97 patients were included.The target serum trough concentration(10-20 mg/L)was reached in only 33.0%(32/97)of the critically ill patients.The serum trough concentration was below the target in 51.5%(50/97)of the patients,above the target in 15.5%of the patients.The clinical cure rate and incidence of renal impairment were significantly different among the three groups of patients with different trough concentrations(P<0.05).The compliance with target serum trough concentration varied with different renal function tests(P<0.05).Augmented renal clearance and normal renal function were associated with trough concentrations lower than the target.As renal dysfunction got worse,serum trough concentration was more probably higher than the target(P<0.05).Univariate analysis showed that daily dose,age,gender,height,weight,body mass index(BMI),APACHE II score,sequential organ failure assessment(SOFA)score,blood creatinine,urea nitrogen,procalcitonin,concomitant septic shock,and use of norepinephrine were significantly correlated with trough concentrations of norvancomycin(P<0.05).Multivariate logistic regression analysis indicated that age,SOFA sc

关 键 词：去甲万古霉素 血药谷浓度 肾功能亢进 治疗药物监测 

分 类 号：R978.1[医药卫生—药品]