68例患者万古霉素稳态谷浓度和血药浓度曲线下面积的监测结果分析  

Analysis of Monitoring Results for Vancomycin Steady-state Trough Concentrations and Area Under the Blood Concentration Curve in 68 Patients

作　　者：刘亭亭 赵宇蕾 陈晓燚 岳慧杰 刘雪姣 LIU Tingting;ZHAO Yulei;CHEN Xiaoyi;YUE Huijie;LIU Xuejiao(Department of Clinical Pharmacy,General Hospital of Eastern Theater Command,Nanjing 210002,China)

机构地区：[1]东部战区总医院临床药学科,南京210002

出　　处：《中国现代应用药学》2024年第19期2711-2717,共7页Chinese Journal of Modern Applied Pharmacy

摘　　要：目的比较万古霉素稳态谷浓度(C_(min))和24 h血药浓度曲线下面积(24 h area under the curve,AUC_(0-24h))的监测结果,并对C_(min)和AUC_(0-24h)超出目标范围上限的情况进行影响因素分析。方法选取2021年9月—2023年3月就诊于东部战区总医院后接受万古霉素治疗并同时测定稳态峰、谷浓度的患者,按照C_(min)是否>20 mg·L^(-1)和AUC_(0-24h)是否>650 mg·h·L^(-1)各分为2组,分别进行相关影响因素分析。结果研究纳入68例患者,共收集103对万古霉素稳态峰浓度和谷浓度。C_(min)超出目标范围上限的比例为48.54%,AUC_(0-24h)超出目标范围上限的比例为49.51%,C_(min)和AUC_(0-24h)之间具有良好的线性相关性(相关系数r=0.9492,P<0.05);住院期间发生急性肾损伤或存在慢性肾脏病病史(OR 7.18,95%CI 1.41~36.53,P<0.05)以及浓度测定后调整给药方案(OR 10.61,95%CI 3.33~33.78,P<0.05)是C_(min)>20 mg·L^(-1)的独立影响因素,而仅浓度测定后调整给药方案(OR 6.15,95%CI 2.05~18.45,P<0.05)是AUC_(0-24h)>650 mg·h·L^(-1)的独立影响因素。结论临床实践中万古霉素C_(min)和AUC_(0-24h)超出目标范围上限的发生率约为50%;虽然浓度测定后多数已调整给药方案,但从安全性角度出发,建议在患者病情危重且已出现急性肾损伤或既往有慢性肾脏病时适当降低初始给药剂量。OBJECTIVE To compare the monitoring results of vancomycin steady-state trough concentration(C_(min))and 24 h area under the curve(AUC_(0-24h)),and analyze the influencing factors of C_(min) and AUC_(0-24h) exceeding the upper limit of the target range.METHODS Patients who received vancomycin treatment in General Hospital of Eastern Theater Command from September 2021 to March 2023 and measured the steady-state peak and trough concentrations at the same time were divided into two groups according to whether C_(min) was greater than 20 mg·L^(-1) and AUC_(0-24h) was greater than 650 mg·h·L^(-1),and the related influencing factors were analyzed respectively.RESULTS The 68 patients were included in the study,and 103 pairs of peak and trough concentrations of vancomycin were collected.The proportions of C_(min) and AUC_(0-24h) exceeding the upper limit of the target range were 48.54%and 49.51%,respectively;there was a good linear correlation between C_(min) and AUC_(0-24h)(correlation coefficient r=0.9492,P<0.05).The presence of acute kidney injury or chronic kidney disease during hospitalization(OR 7.18,95%CI 1.41−36.53,P<0.05)and the adjustment of dosage regimen after concentration determination(OR 10.61,95%CI 3.33−33.78,P<0.05)were independent influencing factors for C_(min)>20 mg·L^(-1),while adjusting the dosage regimen after concentration determination(OR 6.15,95%CI 2.05−18.45,P<0.05)was the independent influencing factor for AUC_(0-24h)>650 mg·h·L^(-1).CONCLUSION The incidence of vancomycin C_(min) and AUC_(0-24h) exceeding the upper limit of the target range in clinical practice is approximately 50%.Although most of them have adjusted the dosage regimen after concentration determination,it is recommended that the initial dose administered should be appropriately reduced when the patients are critically ill with concurrent acute kidney injury or chronic kidney disease.

关 键 词：万古霉素 稳态谷浓度 24 h血药浓度曲线下面积 急性肾损伤 慢性肾脏病 

分 类 号：R969.11[医药卫生—药理学]