伏立康唑治疗药物浓度监测在重症监护病房患者抗真菌治疗中的应用

发布时间：2018-04-25 01:28

本文选题：伏立康唑 + 治疗药物浓度监测　；参考：《中国抗生素杂志》2017年07期

【摘要】：目的探讨对ICU侵袭性真菌病患者进行伏立康唑治疗药物浓度监测的临床意义。方法对诊断为侵袭性真菌病并使用伏立康唑治疗的68例ICU患者进行回顾性分析,按照是否监测伏立康唑药物谷浓度(voriconazole trough concentration,Cvmin)将患者分为对照组(CON)及治疗药物浓度监测组(TDM),其中TDM组患者在伏立康唑治疗期间监测Cvmin,并根据Cvmin调整药物剂量,最后比较两组患者的治疗失败率和药物不良事件发生率。并进一步将TDM组患者按照Cvmin水平分为3个亚组,分别为低于有效治疗浓度组(Cvmin1mg/L),达到有效治疗浓度组(Cvmin在1~4mg/L)和高于有效治疗浓度组(Cvmin4mg/L)。比较不同亚组之间年龄、性别、白蛋白水平和持续肾替代治疗率之间的差异,寻找影响血药浓度的因素。结果和CON组相比,TDM组患者具有更低的治疗失败率,17%vs 3%,P0.01;以及较低的药物不良事件发生率,23%vs 5%,P0.01。3个亚组患者在性别、年龄、体重、白蛋白水平和APAPCHEII评分方面无统计学差异。与达到有效治疗浓度组及高于有效治疗浓度组的患者相比,低于有效治疗浓度组的患者持续肾替代治疗率明显升高,100%vs 52%,P0.05及100%vs 29%,P0.05。结论对于使用伏立康唑治疗侵袭性真菌病的ICU患者,尤其是那些同时接受CRRT治疗的患者,有必要进行治疗药物浓度监测,并根据Cvmin结果适当调整剂量,使药物浓度维持在有效治疗范围内,增加治疗成功率,同时降低药物不良反应的发生率。
[Abstract]:Objective to investigate the clinical significance of Volconazole concentration monitoring in patients with ICU invasive mycosis. Methods Sixty-eight patients with ICU diagnosed as invasive mycosis and treated with Volconazole were retrospectively analyzed. The patients were divided into control group (Conn) and therapeutic drug concentration monitoring group (TDMN) according to whether voriconazole trough concentration was monitored. The patients in TDM group were monitored for CVM during voleconazole treatment and the dosage was adjusted according to Cvmin. Finally, the rate of treatment failure and the incidence of adverse drug events were compared between the two groups. The patients in TDM group were further divided into three subgroups according to the level of Cvmin, which were Cvmin 1 mg / L, Cvmin 4 mg / L and Cvmin 4 mg / L respectively. To compare the age, sex, albumin level and the rate of continuous renal replacement therapy among different subgroups, to find the factors that influence the blood drug concentration. Results compared with the CON group, the TDM group had a lower treatment failure rate (P 0.01) and a lower incidence of adverse drug events (P 0.01). There was no significant difference in sex, age, body weight, albumin level and APAPCHEII score between the two groups in sex, age, body weight, albumin level and APAPCHEII score. Compared with the effective concentration group and the higher effective treatment concentration group, the rate of continuous renal replacement therapy in the lower effective concentration group was significantly higher than that in the effective concentration group vs 52% P 0.05 and 100%vs 29% P 0.05. Conclusion it is necessary to monitor the drug concentration and adjust the dosage according to the results of Cvmin for ICU patients with invasive mycosis treated with Volconazole, especially those who are treated with CRRT at the same time. To maintain drug concentration within the effective range of treatment, increase the success rate of treatment, while reducing the incidence of adverse drug reactions.
【作者单位】：西安交通大学第一附属医院重症医学科;甘肃省金昌市中心医院急救重症中心;西安交通大学第一附属医院神经内科;西安交通大学第一附属医院神经外科;西安交通大学第一附属医院药学部;
【基金】：国家自然科学基金项目(No.81600574)
【分类号】：R978.5

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