美罗培南首次监测稳态血药谷浓度不达标的影响因素分析  

Analysis of Influencing Risk Factors Influencing the First Monitoring of SubstandardSteady-state Blood Trough Concentrations of Meropenem

作　　者：白海悦 余安妮 游翠玉 张迪[1] BAI Haiyue;YU Anni;YOU Cuiyu;ZHANG Di(Department of Pharmacy,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China;Department of Pharmacy,Xi'an Gaoxin Hospital,Xi'an 710075,China;Department of Pharmacy,No.302 Hospital of China Guihang Group,Anshun,Guizhou 561000,China)

机构地区：[1]西安交通大学第一附属医院药学部,西安710061 [2]西安市高新医院药剂科,西安710075 [3]中国贵航集团三〇二医院药剂科,贵州安顺561000

出　　处：《医药导报》2025年第2期281-286,共6页Herald of Medicine

基　　金：国家自然科学基金青年项目(82104295);陕西省重点研发计划一般项目(2021SF-226);西安交通大学第一附属医院重点青年培育项目(2019QN-14)。

摘　　要：目的分析美罗培南首次监测稳态血药谷浓度不达标的影响因素。方法选择西安交通大学第一附属医院2021年7月—2023年6月使用美罗培南治疗并监测稳态血药谷浓度的患者为研究对象,记录患者的年龄、性别等病史资料。测定美罗培南稳态血药谷浓度,并确定靶标。根据监测结果分为达标组(2.0~16.0 mg·L^(-1))和未达标组(低浓度组<2.0 mg·L^(-1)或高浓度组>16.0 mg·L^(-1))。对低浓度组、高浓度组分别与达标组进行相关变量的单因素及多因素logistic回归分析,筛选美罗培南稳态血药谷浓度不达标的危险因素。结果共纳入患者324例,其中血药谷浓度达标者189例,达标率58.33%,未达标者135例(低浓度组86例,高浓度组49例),未达标率41.67%。通过多因素logistic回归分析结果显示,低浓度组与达标组相比,肾小球滤过率、白蛋白及颅脑疾病是美罗培南浓度偏低的危险因素(P<0.05),颅脑损伤患者肾小球滤过率显著高于无颅脑损伤者;胱抑素-C是2组患者中美罗培南浓度达标的保护因素(P<0.05)。高浓度组与达标组比较,美罗培南日剂量及降钙素原是美罗培南血药浓度偏高的危险因素(P<0.05),而肾小球滤过率是2组患者中美罗培南浓度达标的保护因素。结论肾小球滤过率、白蛋白、颅脑疾病是美罗培南稳态血药谷浓度偏低的危险因素,而美罗培南日剂量、降钙素原是美罗培南稳态血药谷浓度偏高的危险因素。Objective To analyze the influencing factors of substandard steady state blood trough concentration of meropenem in the first monitoring.Methods Patients who were treated with meropenem and monitored steady-state blood trough concentration from July 2021 to June 2023 in the First Affiliated Hospital of Xi'an Jiaotong University were selected as the study subjects,and the patient's age,gender,and other medical history data were recorded.The steady-state blood trough concentration of meropenem was determined and the target was identified.According to the monitoring results,the patients were categorized into the standard group(2.0-16.0 mg·L^(-1))and non-standard group(<2.0 mg·L^(-1)in the low concentration group and>16.0 mg·L^(-1)in the high concentration group).Univariate and multivariate logistic regression analyses of relevant variables were performed for the low and high concentration groups,respectively,compared with the standard group to screen for risk factors for substandard steady-state trough concentration of meropenem.Results A total of 324 patients were included,there were 189 cases(58.33%)were reached the standard concentration,while 135 cases(41.67%)were failed to meet the standard(86 cases in low concentration group and 49 cases in high concentration group).The results of multivariate logistic regression analysis showed that glomerular filtration rate(P<0.05),abumin(P<0.05)and craniocerebral diseases(P<0.05)were risk factors in the low concentration group compared with the standard group,the glomerular filtration rate of patients with brain injury was significantly higher than patients without brain injury;cystatin-C(P<0.05)was a protective factor for the concentration of meropenem in both groups.The daily dose of meropenem(P<0.05)and procalcitonin(P<0.05)were risk factors for high meropenem blood concentrations in the high-concentration group compared with the standard group,whereas glomerular filtration rate(P<0.05)was ta protective factor for the concentration of meropenem in the two groups.Conc

关 键 词：美罗培南 浓度不达标 颅脑损伤 肾小球滤过率 影响因素 

分 类 号：R978.1[医药卫生—药品] R969.1[医药卫生—药学]