2015—2016年住院患者万古霉素血药浓度监测分析

了解静脉使用万古霉素的住院患者血药浓度监测及达标情况。收集2015—2016年首都医科大学附属复兴医院静脉使用万古霉素且行血药浓度监测的住院患者,采集患者一般资料、科室、首次采血时间、首次万古霉素血药浓度、是否根据不恰当血药浓度进行万古霉素剂量调整等资料。结果显示,静脉使用万古霉素住院患者的血药浓度送检率仅为43.1%(410/952)。在纳入研究的373例患者中,首次采血时间正确率为19.3%,首次血药浓度达标率为42.9%,科室间送检率差异明显。在万古霉素浓度未达标和超标的213例患者中,调整万古霉素剂量比例仅为34.7%(74/213),且主要在超标者中。提示静脉使用万古霉素的住院患者,血药浓度送检率和首次采血时间正确率均偏低。在未达标或超标者中,根据万古霉素谷浓度调整剂量的比例偏低,特别是未达标者。应重视静脉使用万古霉素血药浓度监测并规范流程。

Monitoring and analysis of trough concentration of vancomycin in hospitalized patients in a tertiary hospital from 2015 to 2016

To investigate the plasma trough concentration of vancomycin in hospitalized patients from a single center.The general information,departments,first time of taking blood,first trough concentration and dose adjustment of vancomycin were collected from inpatients intravenously administrated with vancomycin in Fuxing Hospital,Capital Medical University from 2015 to 2016.During the investigation,the percentage of patients receiving concentration monitor was 43.1%(410/952).Finally 373 patients were included in the study.The rate of correct blood taking was 19.3%,and only 42.9%first trough concentration reached the standard range,with significant difference between departments.Among the 213 patients with lower or higher concentration,the proportion of vancomycin dose-adjustment was only recorded in 34.7%(74/213)patients,mainly in the over-dosing group.It is suggested that the concentration monitoring and the accuracy of blood sampling were inferior.Also,drug dose-adjustment according to concentration was inadequate,especially in the under dose group.In conclusion,monitoring trough concentration of vancomycin and standardizing test process are suggested.