影响万古霉素血药浓度因素及临床药师干预对治疗效果的影响

 目的 探讨影响万古霉素血药浓度因素及临床药师干预对治疗效果的影响情况。方法 选择2018-07至2019-07在医院接受万古霉素血药浓度监测的120例患者,收集临床资料采用Pearson单因素分析及多元Logistic回归分析的方法,对影响万古霉素血药浓度的相关因素进行确定。将万古霉素血药浓度未达标与超标的86例,随机分为干预组与非干预组,每组43例,对临床药师干预效果进行分析。结果 经单因素分析,影响万古霉素血药浓度的因素包括年龄、身体质量指数(body mass index,BMI)、血浆白蛋白水平、肌酐清除率、中重度外周水肿、肝功能异常以及基础性疾病(P<0.05)。将上述单因素分析存在统计学差异的相关因素代入多元Logistic回归模型,结果显示,年龄、中重度外周水肿、肾功能异常及BMI为影响万古霉素血药浓度的相关因素(P<0.05)。干预组血药浓度达标率、患者30 d病死率及不良反应发生率分别为62.79%、2.33%及6.98%,与对照组分别为34.88%、9.30%及18.60%差异有统计学意义(P<0.05)。结论 影响万古霉素血药浓度的相关因素包括年龄、中重度外周水肿、肾功能异常及BMI,对此,临床药师应该强化对血药浓度进行干预,以提高药物效果。

Factors influencing plasma vancomycin concentrations and effect of clinical pharmacist intervention on the clinical outcome

Objective To investigate the factors that influence plasma vancomycin concentrations and the effect of clinical pharmacist intervention on the therapeutic effect. Methods The clinical data of 120 cases of patients who received vancomycin concentration monitoring in our hospital between July 2018 and July 2019 was retrospectively analyzed. The influencing factors of vancomycin plasma concentrations were determined by Pearson single factor analysis and multiple Logistic regression analysis before the cases were randomly divided into the intervention group and the non-intervention group.The effect of intervention by clinical pharmacists was analyzed. Results (1) The influencing factors of plasma vancomycin concentrations included age, BMI, plasma albumin levels, creatinine clearance rate, moderate and severe peripheral edema, abnormal liver function and pre-existing diseases according to univariate analysis(P<0.05). (2) The above-mentioned factors with statistically significant differences by univariate analysis were put into the multiple Logistic regression model, and the results showed that age, moderate and severe peripheral edema, abnormal renal function and BMI were factors that affected the plasma concentration of vancomycin (P<0.05). (3) The compliance rate of serum drug concentrations, 30d mortality rate and incidence of adverse reactions in the intervention group were 62.79%, 2.33% and 6.98% respectively, which were significantly different from those of the control group [34.88%, 9.30% and 18.60% respectively] (P<0.05). Conclusions The influencing factors of blood concentrations of vancomycin include age, moderate and severe peripheral edema, abnormal renal function and BMI. Therefore, clinical pharmacists should strengthen the blood concentration intervention to improve the drug effect.