我院万古霉素治疗药物监测横断面调查
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篇名: 我院万古霉素治疗药物监测横断面调查
TITLE:
摘要: 目的:探讨开展万古霉素治疗药物监测的必要性以及我院在该项工作中存在的问题,为临床合理使用万古霉素提供依据。方法:采用横断面调查的方法,收集2014年全年我院92例接受万古霉素治疗药物监测的患者的临床资料,对192例次血药浓度监测数据进行统计和分析。结果:万古霉素平均血药谷浓度为(15.96±8.06)mg/L;随着患者年龄增长血药谷浓度值相应增加,各年龄组血药谷浓度值之间差异有统计学意义(P=0.000);在第4次给药前30 min获得血药谷浓度数据的只有13例次(6.77%);用药后患者血肌酐和内生肌酐清除率比用药前略有上升,但差异均无统计学意义(P=0.349,P=0.722);有36例(39.13%)培养出对万古霉素敏感的革兰阳性球菌;用药后患者体温、白细胞计数以及中性粒细胞百分比均较用药前有所下降,差异均有统计学意义(P=0.006,P=0.000,P=0.000);在92例患者中共有48例(52.17%)患者的初始治疗给予了负荷剂量,只有15例(16.30%)患者没有合并使用其他抗感染药物。结论:我院目前的万古霉素治疗药物监测中还存在如血药谷浓度达标率只有约一半、监测血药谷浓度的采血时间大多不合理、使用万古霉素的病例病原学检出率低、给予负荷剂量的病例只有约一半等问题。故临床药师对采血时间进行干预是促使治疗药物监测合理化的重要环节。同时,对万古霉素血药浓度监测结果进行数据解读,是临床药师纠正临床监测不合理操作的基本手段,也是防范其肾毒性的必要措施,特别是对重症感染患者、老人、儿童和肾功能不全等特殊人群的用药安全性和有效性具有非常重要的意义。     
ABSTRACT: OBJECTIVE: To explore the necessity of developing therapeutic drug monitoring of vancomycin in our hospital and its existing problems, and provide a reasonable basis for the clinical rational use of vancomycin. METHODS: The cross-sectional survey was designed to collect the clinical data of 92 patients with therapeutic drug monitoring of vancomycin and statistically analyze 192 cases of plasma concentration monitoring data. RESULTS: The average plasma trough concentration was (15.96±8.06) mg/L; with the increase of age, the plasma trough concentration was increasing, there was no significant difference in the plasma trough concentration among different age groups (P=0.000); there were only 13 cases (6.77%) that obtained the plasma trough concentration within 30 min before the fourth dose; after using wancomycin, clearance rates of Cr and the endogenous creatinine were slightly higher than before, but there was no significant difference (P=0.722); 36 cases (39.13%) showed vancomycin susceptible gram positive cocci; after using wancomycin, the body temperature, white blood cell count and neutrophil percentage were lower than before, the differences were statistically significant (P=0.006,P=0.000,P=0.000); 48 cases (52.17%) in treatment received initial loading dose, and only 15 cases (16.30%) did not use in combination with other anti infective drugs. CONCLUSIONS: The results showed there are still a lot of problems in the treatment of vancomycin in our hospital, for example, the standard rate of the plasma trough concentration is about 50%; most of the time of blood sampling is not reasonable; the detection rate of the pathogen is low; only about half of the cases are given the loading dose, etc. Therefore clinical pharmacists’ intervention for blood sampling is an important part to promote rational drug therapy monitoring. Meanwhile, data interpretation of the monitoring results of serum drug concentration of vancomycin is a basic method for clinical pharmacists in clinical monitoring to correct the unreasonable operations, and also the necessary measures for preventing the drug renal toxicity, it is a very important significance for the medication safety and effectiveness especially in severe infection patients, the elderly, the children and the people with renal function insufficiency.
期刊: 2016年第27卷第24期
作者: 郭冬杰,李朋梅,杜雯雯,崔刚,陈文倩,张相林
AUTHORS: GUO Dongjie,LIN Pengmei,DU Wenwen,CUI Gang,CHEN Wenqian,ZHANG Xianglin
关键字: 万古霉素;治疗药物监测;血药谷浓度;疗效;横断面调查
KEYWORDS: Vancomycin; Herapeutic drug monitoring; Plasma trough concentration; Efficay; Cross-sectional survey
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