万古霉素血药浓度监测的临床应用

目的：通过监测万古霉素血药浓度，分析血药浓度与疗效、药物不良反应的关系，指导万古霉素在耐甲氧西林葡萄球菌（M RS ）等革兰阳性球菌感染中的合理用药。方法在有指征应用万古霉素的M RS等革兰阳性球菌感染患者中进行该药药物浓度监测。留取血样时间为万古霉素给药至少4个剂量后，在给药前30 min内采血送检谷浓度，给药结束后30 min至1 h内采血送检峰浓度，采用荧光偏振免疫法测定万古霉素血药浓度，同时收集临床资料，进行统计分析。结果25例患者万古霉素血药谷浓度为3．22-50．79 mg／L ，谷浓度＜5 mg／L者3例，5-＜10 mg／L者11例，10-15 mg／L者3例，＞15 mg／L者8例；峰浓度为13．57-60．47 mg／L ，峰浓度＜25 mg／L者14例，25-40 mg／L者7例，＞40 mg／L者4例。感染患者临床好转率为80．0％（20／25）；细菌清除率为87．5％（21／24）。13例患者根据血药浓度监测结果调整用药剂量，其治疗好转率为92．3％（12／13）。4例患者出现肾功能损害。结论万古霉素血药浓度个体差异较大，通过监测血药浓度制定的万古霉素个体化给药方案用于治疗M RS等革兰阳性球菌感染可提高治愈率，减少药物不良反应。

Application of therapeutic drug monitoring of vancomycin

Objective To analyze the relationship between plasma concentration and efficacy , adverse drug reactions by monitoring vancomycin serum concentrations for appropriately treating the infections caused by methicillin‐resistant Staphylococcus aureus or other gram‐positive cocci .Methods Vancomycin concentration was monitored in the patients with indications for vancomycin therapy .Blood sample was taken after vancomycin was administered for at least 4 doses .The blood sample collected within 30 minutes before dosing was used to determine the trough blood concentration .The samples were taken within 30 minutes to 1 hour after infusion of vancomycin were used to estimate the peak concentration by fluorescence polarization immunoassay .The clinical data were collected at the same time to analyze clinical efficacy and safety .Results Vancomycin trough concentration ranged from 3 .22 mg/L to 50 .79 mg/L in 25 patients ,specifically ,〈 5 mg/L in 3 cases ,5‐〈10 mg/L in 11 cases ,10‐15 mg/L in 3 cases ,and 〉 15 mg/L in 8 csaes .Peak concentration ranged from 13 .57 mg/L to 60 .47 mg/L ,specifically ,〈 25 mg/L in 14 cases ,25‐40 mg/L in 7 cases ,and 〉 40 mg/L in 4 cases .The infection was cured in 80 .0% （20/25） of the patients .The gram‐positive cocci were eradicated in 87 .5% （21/24） of the patients .The dosage of vancomycin was adjusted in 13 patients according to the results of blood concentration monitoring .Majority of these patients （12/13 ,92 .3% ） were cured .Renal impairment was observed in 4 patients .Conclusions Vancomycin is safe and effective in treatment of methicillin‐resistant Staphylococcus aureus and other gram‐positive bacterial infections . Vacomycin concentration varies from person to person . Serum concentration monitoring is required to achieve best outcomes and the goal of individualized treatment of vancomycin.