老年重症感染患者万古霉素高谷浓度用药方案的探讨

目的：探讨老年重症感染患者万古霉素高谷浓度用药方案，为临床合理用药提供参考。方法将56例年龄≥65岁的老年重症感染患者按照内生肌酐清除率（Ccr）分为A（Ccr≥50 ml/min）、B（Ccr 20～50 ml/min）两组。对每组患者万古霉素用药剂量、万古霉素稳态血药谷浓度，以及用万古霉素前、后肾功能变化进行统计分析。结果 A组患者31例（25例用万古霉素1 g、q 12 h；6例0．5 g、q 12 h），B组患者25例（15例用万古霉素1 g、q 12 h；10例0．5 g、q 12 h）。 A组中两种用药方案的患者谷浓度在10～20 mg/L有效范围的比例分别为72％（18/25）和33．33％（2/6），谷浓度＜10 mg/L的比例分别为12％（3/25）和66．67％（4/6）；B组中两种用药方案的患者谷浓度在10～20 mg/L有效范围的比例分别为20％（3/15）和60％（6/10），谷浓度＞20 mg/L的比例分别为73．33％（11/15）和30％（3/10）；全部病例除B组万古霉素用量1 g，q 12 h的15例患者用药前、后血肌酐值明显升高（P＜0．05），尿素氮无明显变化（P＞0．05），其他患者用药前、后血肌酐和尿素氮均无明显变化（P＞0.05）。 B组有5例患者出现肾毒性，其万古霉素用量为1 g、q 12 h，谷浓度均＞30 mg/L；A组患者无肾毒性发生。结论老年重症感染患者应根据Ccr情况决定万古霉素用量。 Ccr≥50 ml/min者，万古霉素用量为1 g，q 12 h；Ccr在20～50 ml/min的患者，万古霉素用量为0．5 g，q 12 h；由于个体差异，老年患者应重视监测血药谷浓度，根据血药谷浓度及时调整用药方案。

Investigation of the vancomycin trough concentration in elderly patients with severe infection

Objective To investigate the vancomycin trough concentration in elderly patients with severe infection and provide references for clinical use of drugs effectively .Methods According to the Ccr of elderly patients （56 cases）, who were ≥65 years old, the patients were divided into two groups , one with Ccr≥50 ml/min, which named group A , the other with Ccr between 20 ml/min and 50 ml/min, which named group B .The use of vancomycin , vancomycin steady-state plasma trough concentration and the differences of renal function were analyzed before and after in both two groups .Results There were 31cases of patients in group A （25 cases of them use vancomycin 1 g,q 12 h;other 6 cases use 0.5 g,q 12 h）, 25 cases of patients in group B （15 cases of them use vancomycin 1 g, q 12 h;other 10 cases use 0.5 g,q 12 h） .The percentage that the trough concentration of the patients who use two different scheme of using drugs in group A was between 10 mg/L and 20 mg/L is 12%（3/25） and 66.67%（4/6）.The percentage that the trough concen-tration of the patients who used two different scheme of using drugs in group B was between 10 mg/L and 20 mg/L is 20%（3/15） and 60%（6/10）.The percentage that trough concentrationis more than 20 mg/L is 73.33%（11/15） and 30%（3/10）.The serum creat-inine value of the 15 patients of all cases except for group B of which vancomycin dosage was 1 g, q 12 h had significantly risen after using the drug（P〈0.05）.The urea nitrogen had no obvious change （P〉0.05）.The serum creatinine value and urea nitrogen of oth-er patients had no significant change after using the drug （P〉0.05）.Group B had kidney toxicities observed in 5 patients, the dosage of vancomycin was 1 g, q 12 h, valley concentration 〉30 mg/L.There was no kidney toxicities observed in group A .Conclusion The use of vancomycin in elderly patients must depend on their Ccr .If the Ccr was larger than 50 ml/min, the use of vancomycin should be 1 g,q 12 h, and the Ccr was between 20 ml/min and 50 ml