老年患者应用万古霉素的治疗药物监测与肾毒性评价

目的：评价老年患者应用万古霉素的谷浓度和临床疗效、肾毒性的相关性。方法：回顾性分析，选取我院应用万古霉素并监测其血药浓度的69例老年住院患者，按血药谷浓度监测结果划分为L（<10 mg·L-1）、M（10~20 mg·L-1）、H（>20 mg·L-1） 3组，分别对其血药浓度、临床疗效评定结果、肾功能指标进行统计分析。结果：L、M、H 3组临床有效率分别为88.24%、76.92%、38.47%，肾损伤发生率分别为0.00%、7.69%、30.77%，差异均有统计学意义（P=0.007、P=0.016）。L和M组疗效和肾功能损伤发生率无显著性差别，两组疗效均显著性高于H组，肾功能损伤发生率显著性低于H组。结论：万古霉素谷浓度高于20 mg·L-1并不能进一步提高临床疗效，反而会引起肾功能损伤。老年患者在治疗过程中需监测万古霉素谷浓度，以减少不良反应的发生。

Research on the Therapeutic Drug Monitoring and Nephrotoxicity of Vancomycin in Elderly Patients

Objective: To investigate the correlation between the trough concentration of vancomycin and efficacy plus nephrotoxicity. Methods: Sixty-nine senile inpatients treated with vancomycin were enrolled in this study. These inpatients were divided into 3 groups according to the concentrations of vancomycin, namely group L (<10 mg·L-1), group M (10-20 mg·L-1) and group H (>20 mg·L-1). The trough concentrations of vancomycin, the efficacy and renal indexes of these inpatients were monitored and recorded. Results: There were significant differences among the 3 groups in terms of clinical efficacy and kidney injury rates. Furthermore, there was no significant difference between group L and M in the rates of efficacy and kidney injury. The efficacy rates of group L and M were significantly higher than that of group H, while their kidney injury rates were significantly lower than that of group H. Conclusions: The trough concentration of vancomycin above 20 mg·L-1 might induce nephrotoxicity without improvement of therapeutic efficacy. Therefore the trough concentration of vancomycin in senile patients should be monitored to reduce side-effects.