173例次万古霉素血药浓度监测与临床应用分析

目的：分析某院万古霉素（VAN）血药浓度监测结果，为临床合理应用提供依据。方法：采用酶放大免疫分析法监测VAN血药浓度，并对该院2013-2017年113例患者173例次VAN血药浓度监测结果进行回顾性总结分析。结果：VAN血药质量浓度均值为（17.7±14.2）μg·mL^-1，在治疗窗范围内（10~20 μg·mL^-1）的仅占31.79%，其中首次监测在治疗窗范围内的仅占28.57%，达到中毒浓度（>20 μg·mL^-1）的患者占32.95%；>60岁组患者进行血药浓度监测的比例最大（38.73%），且血药浓度均值（23.9±17.4）μg·mL^-1超出治疗窗范围；日剂量<2 g组，<18岁及>60岁患者血药浓度均值都达到中毒浓度；肾功能异常患者与肾功能正常患者血药谷浓度有显著性差异。结论：VAN血药浓度个体差异较大，该院VAN血药浓度在治疗窗内的比例较低，需加强血药浓度监测；临床医生和药师需重视血药浓度结果与临床应用相结合，及时调整给药方案，实现个体化给药。

Analysis of serum concentration monitoring and clinical application of vancomycin in 173 cases

OBJECTIVE To analyze the serum concentration monitoring of vancomycin in our hospital to provide references for rational clinical use.METHODS Enzyme amplification immunoassay was used to determine the results of VAN serum concentration for 173 cases of 113 patients between 2013 and 2017 in our hospital, and the results were retrospectively analyzed and summarized.RESULTS The average trough concentration of VAN was (17.7±14.2) μg·mL^-1. Vancomycin trough concentration within the therapeutic scope (10-20 μg·mL^-1) accounted for 31.79%, and the results of first monitoring within the therapeutic scope accounted for 28.57%; 32.95% patients reached toxic concentration of higher than 20 μg·mL^-1. Most patients with vancomycin serum concentration monitoring were elderly patients, and patients older than 60 years accounted for 38.73% with average trough concentration (23.9±17.4) μg·mL^-1 out of therapeutic scope. When the daily dose was less than 2 g, the patients younger than 18 years and older than 60 years were beyond the upper limit of the therapeutic scope. The difference of trough concentration was significant between the patients with normal renal function and patients with impaired renal function.CONCLUSION Individual difference of vancomycin plasma concentration is distinct, and the proportion within the therapeutic scope is low in our hospital. It is necessary to strengthen vancomycin serum concentration monitoring. Clinicians and pharmacists need to pay more attention to vancomycin serum concentration results combined with clinical applications to modulate dosage regimen timely and implement individualized medication.