万古霉素血药浓度监测和肾毒性及临床疗效关系的研究

发布时间：2018-03-31 21:25

本文选题：万古霉素　切入点：肾毒性　出处：《现代中西医结合杂志》2016年29期

【摘要】：目的探讨万古霉素血药浓度与肾毒性之间的关系,对患者预后的影响及增加肾毒性的危险因素。方法选择符合标准的住院期间静脉用万古霉素且监测血药浓度的患者105例,收集患者性别、年龄、感染部位、科室分布情况、病原学检查情况等资料,统计万古霉素谷浓度、峰浓度及不同谷浓度下肾毒性发生率;根据万古霉素用药期间是否出现肾毒性分为肾损伤组与非损伤组,比较2组万古霉素谷浓度、峰浓度,用药前后血肌酐值、肌酐清除率,合并疾病情况,同时使用抗生素及其他药物情况。结果 105例患者共行血药浓度监测125例次,谷浓度20 mg/L与≥20 mg/L的肾毒性发生率分别为7.57%和46.15%,二者比较差异有统计学意义(P0.05)。肾损伤组的谷浓度中位数达26.1 mg/L,非损伤组中位数13.2 mg/L,肾损伤组明显高于非损伤组(P0.05);肾损伤组合并糖尿病比例和使用升压药比例均明显高于非损伤组(P均0.05)。革兰阳性菌感染者40例经万古霉素治疗后,临床有效率为57.5%;细菌学清除率32.5%,未清除率20%,病原菌转为革兰阴性菌3例,未复查16例。结论高的万古霉素谷浓度可增加肾毒性的风险,谷浓度≥20mg/L肾毒性发生率明显增加;若患者合并糖尿病或使用升压药,将增加肾毒性的风险。
[Abstract]:Objective to investigate the relationship between the concentration of vancomycin in serum and renal toxicity, the impact on prognosis and increase the risk of renal toxicity factors. Methods to choose the standard of hospitalization in 105 cases of intravenous vancomycin and monitoring the blood concentration of patients, collected from patients with gender, age, site of infection, Distribution Department, etiological examination etc. statistical data, vancomycin trough concentrations, the incidence of renal toxicity and the peak concentration of different concentration; according to whether the renal toxicity of vancomycin during treatment is divided into kidney injury group and non injury group, compared 2 groups of vancomycin trough concentrations, peak concentration, serum creatinine values before and after treatment, the creatinine clearance rate, comorbidities, and the use of antibiotics and other drugs. 105 cases of patients with a total of 125 cases of blood concentration monitoring results, the renal toxicity of 20 mg/L and the minimum concentration of more than 20 mg/L were 7.57% and 46.15%, two The difference was statistically significant (P0.05). The median Valley concentration up to 26.1 mg/L renal injury group, non injury group median 13.2 mg/L, kidney injury group was significantly higher than that of non injury group (P0.05); kidney injury combined with diabetes and the proportion of use of vasopressors were significantly higher than those in non injury group (P 0.05) of gram. Positive bacterial infection in 40 cases after vancomycin treatment, the clinical effective rate was 57.5%; the bacterial clearance rate was 32.5%, no clearance rate was 20%, the pathogenic bacteria to gram negative bacteria in 3 cases, 16 cases were not. The risk of high concentrations of vancomycin trough conclusion can increase renal toxicity, kidney toxicity occurred more than 20mg/L concentration the rate increased significantly; if patients with diabetes or the use of vasopressors, will increase the risk of renal toxicity.

【作者单位】：上海交通大学医学院附属新华医院;
【基金】：上海市科学技术委员会基金项目(13ZR1426500) 2013—2014年度国家临床重点专科建设项目
【分类号】：R969

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