64例老年患者万古霉素血药浓度监测结果分析

目的:通过分析64例老年肺部感染患者万古霉素血药浓度的监测结果,为临床合理用药提供参考.方法:采用荧光偏振免疫法测定万古霉素的血药浓度,对64例157例次血药浓度监测结果进行比较分析.结果:患者万古霉素血清峰浓度和谷浓度均在治疗窗范围内的仅占40% 左右,而谷浓度高于正常范围及峰浓度低于正常范围的约占50% ;首剂饱和方案组与首剂未饱和方案组中血清峰浓度比较有显著性差异,而谷浓度无显著性差异;肾功能正常组患者用药前、后内生肌酐清除率有显著性差异,尿素氮无显著性差异,而肾功能损害组患者用药前、后尿素氮及内生肌酐清除率均无显著性差异;近45% 的患者给药方案为500 mg,每日2~3 次,约75% 的患者未能达到有效峰浓度,约60% 的患者谷浓度超过正常水平.结论:老年感染患者使用万古霉素个体差异很大且多数患者伴有肾功能轻中度损害,应尽量给予首剂饱和方案并对其进行血药浓度监测,以利于实现个体化给药,进而提高该药应用的有效性和安全性.

Analysis on therapeutic drug monitoring data of vancomycin in 64 elderly patients

Objective： To provide reference for vancomycin usage in the clinical practice through the analysis on drug monitoring data of vancomycin in 64 elderly patients with lung infection. Methods： Fluorescence polarization immunoassay method （FPIA） was used to determine vancomycin serum concentration by means of a comparative analysis of 157 blood concentration monitoring results of 64 patients. Results： The serum peak concentration and trough concentration of vancomycin within the therapeutic scope accounted for only 40%, while the rate of the trough concentration above the normal range and the peak concentration below the normal range were nearly 50%; the serum peak concentration had a significant difference between the first dose of saturated program and the first dose of unsaturated program, however there was no special difference in the trough concentration. For patients with normal renal function before treatment and after treatment, the difference of creatinine clearance rate was statistically significant, but there was no significant difference in BUN. While there was no significant difference in creatinine clearance rate and BUN for patients with impaired renal function. Nearly 45% of the dosage regimen was 500 mg, bid or tid. Approximate 75% of patients in this program failed to achieve the effective peak concentration, and trough concentration of about 60% of patients exceeded the normal levels. Conclusion： There are marked individual differences among the elderly infected patients using vancomycin and most of them were with mild to moderate renal dysfunction. The elderly patients should be given first dose of saturated program and vancomycin serum concentrations monitoring should be closely combined with clinical practice. Then individualized administration should be adopted to improve the efficacy and safety of the drug application.