颅脑术后肾功能亢进对万古霉素药动学及药效学的影响  

Effect of augmented renal clearance after cranial surgery on the pharmacokinetics and pharmacodynamics of vancomycin

作　　者：孙雪颖[1] 王波 Xueying SUN;Bo WANG(Procurement Office The Eighth People's Hospital of Qingdao Shandong Qingdao 266000,China;Department of Clinical Laboratory,The Eighth People's Hospital of Qingdao,Shandong Qingdao 266000,China)

机构地区：[1]青岛市第八人民医院采购办公室,山东青岛266000 [2]青岛市第八人民医院检验科,山东青岛266000

出　　处：《临床药物治疗杂志》2024年第10期65-69,共5页Clinical Medication Journal

摘　　要：目的探讨颅脑术后肾功能亢进(ARC)对万古霉素药动学及药效学的影响。方法选取2021年2月至2023年2月青岛市第八人民医院颅脑术后行万古霉素抗感染后发生ARC的患者45例(ARC组),按1∶3同期选取未发生ARC的患者135例(对照组)。监测患者万古霉素血药浓度相关指标及药动学参数,分别于治疗前后测量两组患者的临床指标,统计万古霉素用药疗程及住院时间。结果ARC组中1例中途死亡,对照组中5例更换治疗方案,3例中途转院,2例中途死亡,最终纳入ARC组44例,对照组125例。ARC组血药浓度达稳态时间、平均谷浓度及谷浓度达标率低于对照组[(3.61±1.26)d比(4.95±1.53)d、(8.49±2.14)mg/L比(13.46±4.09)mg/L、18.18%比48.00%],万古霉素日均给药剂量高于对照组[(2171.26±359.33)mg比(1846.17±316.26)mg],差异均有统计学意义(P<0.05);ARC组万古霉素清除率、万古霉素表观分布容积水平高于对照组[(6.91±1.19)L/h比(4.26±1.01)L/h、(69.02±16.26)L比(61.21±13.59)L],终端半衰期及药-时曲线下面积低于对照组[(3.55±1.25)h比(4.28±1.94)h、(301.26±95.77)h·mg/L比(365.79±112.54)h·mg/L],差异均有统计学意义(P<0.05);两组患者治疗后的体温、中性粒细胞百分比、白细胞计数、降钙素原及C反应蛋白水平均低于治疗前,脑脊液葡萄糖/血清葡萄糖比值高于治疗前,差异均有统计学意义(P<0.05),治疗后两组各临床指标比较,差异均无统计学意义(P>0.05);ARC组万古霉素用药疗程、ICU住院时间及总住院时间较对照组延长[(6.91±1.18)d比(4.26±1.0)d、(5.95±1.18)d比(4.16±1.43)d、(22.70±5.16)d比(20.76±4.72)d],差异均有统计学意义(P<0.05)。结论颅脑术后ARC能够降低万古霉素血药浓度,影响药动学及疗效,延长用药疗程及住院时间。Objective To investigate the effect of augmented renal clearance(ARC)after cranial surgery on the pharmacokinetics and pharmacodynamics of vancomycin.Methods A total of 45 patients(ARC group)were selected after receiving anti-infection vancomycin after craniocerebral surgery in the Eighth People's Hospital of Qingdao from February 2021 to February 2023.A total of 135 patients without ARC(control group)were selected according to 1∶3 in the same period.Blood concentration and pharmacokinetic parameters of vancomycin were monitored,and clinical indicators of the two groups were measured before and after treatment,and the duration of vancomycin administration and hospital stay were counted.Results One case died in the ARC group,5 cases in the control group changed treatment regimens,3 cases were transferred to the hospital,and 2 cases died in the middle of the group,and 44 cases in the ARC group and 125 cases in the control group were finally included.The time of stable state of plasma concentration,average trough concentration and the rate of meeting the standard of trough concentration in ARC group were lower than those in control group[(3.61±1.26)d vs(4.95±1.53)d,(8.49±2.14)mg/L vs(13.46±4.09)mg/L,18.18%vs 48.00%].The average daily dose of vancomycin was higher than that of control group[(2171.26±359.33)mg vs(1846.17±316.26)mg],and the differences were statistically significant(P<0.05).The vancomycin clearance rate and apparent volume distribution of vancomycin in ARC group were higher than those in control group[(6.91±1.19)L/h vs(4.26±1.01)L/h,(69.02±16.26)L vs(61.21±13.59)L].Terminal half-life and area under drug-time curve were lower than those of control group[(3.55±1.25)h vs(4.28±1.94)h,(301.26±95.77)h·mg/L vs(365.79±112.54)h·mg/L],and the differences were statistically significant(P<0.05).Body temperature,neutrophil percentage,white blood cell count,procalcitonin and C-reactive protein levels after treatment were lower than those before treatment,and the ratio of cerebrospinal fluid glucose

关 键 词：颅脑术后 肾功能亢进 万古霉素 血药浓度 药动学 疗效 

分 类 号：R978.1[医药卫生—药品]