某院2010～2012年度万古霉素血药浓度监测结果分析

目的分析北京某三甲医院万古霉素血药浓度的监测情况,促进临床个体化用药。方法收集我院2010～2012年度测定万古霉素血药浓度和使用万古霉素患者的资料,回顾性分析万古霉素血药浓度变化情况。结果 2010～2012年共有314例患者进行了652例次万古霉素监测,其中测2小时峰浓度的154例次(23.62%),血药浓度低于25μg·mL-1的有81例次(52.60%),在25～40μg·mL-1的有54例次(35.06%),大于40μg·mL-1的有19例次(12.34%)。测谷浓度的有498例次(76.38%),按照Geraci标准,万古霉素谷浓度的范围应在5～10μg·mL-1,在测定谷浓度的498例次中,血药浓度小于5μg·mL-1的有66例次(13.25%),在5～10μg·mL-1之间的有153例次(30.72%),大于10μg·mL-1的有279例次(56.02%);若按照美国《万古霉素治疗成人金黄色葡萄球菌感染的治疗监测实践指南》,谷浓度范围应在15～20μg·mL-1,在这498例次中,有366例次(73.49%)血药浓度低于15μg·mL-1,64例次(12.85%)血药浓度在15～20μg·mL-1之间,68例次(13.65%)血药浓度大于20μg·mL-1。结论我院万古霉素血药浓度监测力度不足,应加大宣传,提高临床医生送检意识。其次,药师应加强与临床医生的沟通与合作,研究万古霉素血药浓度和患者疗效的关系,结合研究结果探索适合中国人群的万古霉素治疗窗。

Analysis of Blood Concentration Monitoring of Vancomycin in the Hospital from 2010 to 2012

Objective To analyze the monitoring results of drug concentration in serum of vancomycin in Beijing Hospital and promote the individual administration of vancomycin.Methods The valid data of vancomycin in the hospital from 2010 to 2012 were retrieved,and a retrospective analysis was made on the distribution of blood concentration.Results There were 652 cases of 314 patients who were monitored vancomycin serum concentrations from 2010 to 2012.In the 652 cases of vancomycin surveyed,there were 154（23.62%） cases were monitored 2 hours peak concentration.Among them there were 81（52.60%） cases lower 25 μg.mL-1and 54（35.06%） cases of 25～40 μg.mL-1and 19（12.34%） cases over 40 μg.mL-1.In the 652 cases of vancomycin surveyed,there were 498（76.38%） cases were monitored trough concentration.According to the standard of Geraci（therapeutic window of vancomycin： 5～10 μg.mL-1）,there were 66（13.25%） cases lower 5 μg.mL-1 and 153（30.72%） cases of 5～10 μg.mL-1 and 279（56.02%）cases over 10 μg.mL-1.According to the standard of vancomycin therapeutic guidelines（therapeutic window of vancomycin：15～20 μg.mL-1）,there were 366（73.49%） cases lower 15 μg.mL-1 and 64（12.85%） cases of 15～20 μg.mL-1 and 68（13.65%） cases over 20uμg.mL-1.Conclusion The intensity of vancomycin serum concentration monitoring was insufficient in Beijing Hospital.We should take action to strengthen publicity and encourage clinicians to raise awareness of detection.Secondly,another goal is to improve communications between clinicians and pharmacists.The vancomycin serum concentration monitoring should be closely combined with clinical practice and a further study should be conducted to investigate the therapeutic window of vancomycin for the Chinese population.