万古霉素对老年患者肾毒性的观察及血药浓度监测的意义

目的 探讨老年患者使用万古霉素治疗过程中进行肾毒性观察及血药浓度监测的意义。方法 对69例明确有金黄色葡萄球菌感染的老年住院患者予万古霉素500mg或去甲万古霉素400mg静滴，每8小时1次，平均疗程11d，观察用药前后肾功能指标的变化。31例患者在药物治疗过程中监测万古霉素血药浓度，根据检查结果调整治疗方案。结果 65例老年患者在应用万古霉素前后血清肌酐、血尿素氮、内生肌酐清除率的变化差异无统计学意义（P〉0．05）。结论 老年患者应用万古霉素大多数是安全的，根据内生肌酐清除率调整用药剂量及（或）进行血药浓度监测，进行个体化给药，可以提高该药应用的安全性和有效性。

The significance on measurations of blood drug concentration of vancomycin and renal toxicity observations for the old patients

Objective To determine the significance between measurations of blood drug concentration and renal toxicity in using vancomycin to treat old patients.Methods Vancomycin 500mg or Noradvancomycin 400mg i.v.q8h was used in 69 old patients with infections of staphylococcus aureus,the average period of treatment 11 days.Changes of renal functions were observed before and after using the medicine.Vancomycin's blood drug level was measured while the course of treatment in 31 patients and then were readjusted the dosage of vancomycin.Results There were no significant changes(P>0.05) in blood serum creatinine,urea nitrogen,and endogenous creatinine clearance rate between before and after using vancomycin in 65 old patients.Conclusions Mostly it is safely using the vancomycin in old patients.It can be increased in the security and validity according to endogenous creatinine clearance rate and measuration of blood drug concentration when used vancomycin.Individualization for usage of the vancomycin is helpful.