万古霉素血药浓度监测应用调查及分析

目的 通过对154例患者434例次万古霉素血药浓度监测,结合疗效、不良反应及药敏结果进行统计分析,为临床合理应用万古霉素提供依据.方法 收集本院2012年154例434例次万古霉素血药浓度的监测结果,结合临床病历资料、病原学检查、肾功能指标、合并用药及发生的不良反应情况进行汇总分析,同时分析万古霉素的最低抑菌浓度（MIC）与疗效的关系.结果 434例次万古霉素血药浓度的监测结果中,血药谷浓度10～20 μg·mL^-1共有214例次（占49.29％）,＜10 tg·mL^-1共有81例（占18.69％）,＞20 μg·mL^-1共有139例（占32.02％）;单独使用万古霉素共12例（占7.79％）,联合使用一种抗感染药物共40例（占24.03％）,联合使用两种或两种以上抗感染药物共102例（占68.18％）;不良反应发生率为32.47％.结论 应加强对万古霉素临床治疗药物的监测,根据测得的血药浓度对给药剂量进行适当的调整,实现个体化给药,从而达到提高疗效、降低毒性发生率,实现合理用药的目的.

Investigation and Analysis of Plasma Concentration Monitoring of Vancomycin

Objective To analyze the data of vaneomycin plasma concentration in 434 cases of 154 patients for providing a reasonable basis for the clinical use of vancomycin. Methods A retrospective analysis of the data of vancomycin plasma concentration in 434 cases of 154 patients in 2012 was conducted for the study of vancomycin minimum inhibitory concentration （MIC） and curative effect, and then the pathologic examination and renal function of patients, combined medication and adverse drug reactions of vancomycin were analyzed. Results Among the 434 cases, there were 214 cases （49.29%） with vancomycin trough blood concentration of 10-20 μg · mL^-1, 81 cases （18.69%） with vancomycin trough blood concentration below 10μg · mL^-1 , 139 cases （32.02%） with vancomycin trough blood concentration above 20 μg · mL^-1. In 12 cases, vancomycin was used alone （7.79%）. In 40 cases, vancomycin was used in combination with another antibiotic （24. 03%）. In 102 cases, vancomycin was used in combination with two or more other antibiotics （68.18%）. Adverse reaction incidence rate of vancomycin was 32.47%. Conclusion The monitoring of clinical application of vancomycin should be strengthened to make an appropriate adjustment for individualized dosing regimen according to the plasma concentration measured, so as to improve the efficacy and reduce the incidence of toxicity of vancomycin.