万古霉素初始谷浓度影响因素及相关性研究

目的探讨万古霉素初始谷浓度的影响因素及其相关性。方法选取南通大学附属医院2016年1月至2018年12月使用万古霉素进行血药浓度监测的患者100例,分析万古霉素临床使用时病原菌分布和不良反应发生情况,回顾性调查患者的一般资料、白蛋白水平、是否行机械通气、药物用法用量等及血药谷浓度监测数据,以多因素Logistic回归分析万古霉素初始谷浓度与其影响因素的相关性。结果100例患者共分离47株革兰阳性病原菌,万古霉素的细菌清除率为91.49%;使用万古霉素前后患者的肾功能无明显差异(P<0.05),2例患者出现肾毒性;按药品说明书要求每日2 g给药的仅有37例(占52.86%)谷浓度达标;多因素Logistic回归模型分析结果显示,患者年龄、入住病区、机械通气是引起万古霉素初始谷浓度低的独立影响因素(P<0.05)。结论万古霉素疗效明确,但初始谷浓度影响因素较多,临床应实施个体化给药方案。

Influence Factors Affecting Initial Trough Concentration of Vancomycin and the Correlation Study

Objective To explore the influence factors of the initial trough concentration of vancomycin and its correlation.Methods A total of 100 patients who used vancomycin for blood drug concentration monitoring from January 2016 to December 2018 in the Affiliated Hospital of Nantong University were selected to analyze the distribution of pathogenic bacteria and adverse reactions during the clinical use of vancomycin.The data,albumin levels,mechanical ventilation,drug usage and dosage,and blood drug valley concentration monitoring data were used to analyze the correlation between the initial trough concentration of vancomycin and its influencing factors by multi-factor Logistic regression.Results A total of 47 Gram-positive pathogens were isolated from 100 patients.The bacterial clearance rate of vancomycin was 91.49%;there was no significant difference in renal function between patients before and after vancomycin administration(P<0.05);two patients developed nephrotoxicity;only 37 patients who were administered 2 g per day as required by the drug instructions(accounting for 52.86%)reached the trough concentration standard;multivariate Logistic regression model analysis showed that age,admission to the ward,and mechanical ventilation were independent factors that caused the initial trough concentration of vancomycin to be low(P<0.05).Conclusion Vancomycin has a definite curative effect,but there are many factors affecting the initial trough concentration,so individualized dosage regimen should be implemented in the clinic.