决策树解读万古霉素血药浓度的临床应用

目的 评估基于群体药动学模型的万古霉素血药浓度解读决策树的临床应用效果.方法 以前期建立的万古霉素血药浓度解读决策树为基础,在分层解读前加入标本评价环节.收集使用万古霉素抗感染治疗并监测血药浓度的住院患者病例,以改进后的决策树为指导,采用SmartDose软件预测血药浓度,辅助临床制定个体化给药方案.结果 在决策树的标...

Clinical application of vancomycin blood concentration interpretation by decision tree

AIM To evaluate the clinical efficacy of decision tree on vancomycin plasma concentration interpretation based on population pharmacokinetic model.METHODS On the basis of the decision tree of vancomycin plasma concentration interpretation in early stage,the sample evaluation was added before the hierarchical interpretation.Clinical data were prospectively collected from inpatients in vancomycin anti-infection treatment and plasma concentrations monitoring.Guided by the improved decision tree,SmartDose software was used to predict the vancomycin plasma concentration and adjust the dosage,assisting the clinical development of individualized administration plan.RESULTS There were 29 cases found to be unqualified in the trough concentration of vancomycin in the sample evaluation process.After the communication of sample collection standards,the samples were collected again and finally 145 cases were classified and interpreted.Among them,vancomycin plasma concentration was less than 5 mg·L^-1 in 7 cases(4.8%),5 to<10 mg·L^-1 in 25 cases(17.2%),10 to 20 mg·L^-1 in 90 cases(62.1%),higher than 20 mg·L^-1 in 23 cases(15.9%).SmartDose software was employed to assist the adjustment of the vancomycin dosage regimen in 45 cases,and 30 cases of them were accepted by clinicians.The vancomycin plasma concentrations of the patients who adopted the adjustment dosage were re-measured,and the prediction accuracy was 100%.Compared with patients who did not adopt the adjustment dosage,patients who adopted the adjustment showed higher clinical improvement rate(87%vs.60%,P<0.05)and lower nephrotoxicity incidence(0 vs.27%,P<0.05).CONCLUSION Clinical application of decision tree on vancomycin plasma concentration interpretation can comprehensively improve the efficacy and safety of vancomycin,and help to develop its clinical application value.