老年人群万古霉素相关急性肾损伤现状调查及其风险因素

发布时间：2018-10-04 18:38

【摘要】：目的:研究老年患者服用万古霉素(vancomycin,VAN)后万古霉素相关急性肾损伤(vancomycin induced acute kidney injury,VI-AKI)的发生情况及其风险因素,同时完善合并药物的研究,并进一步考察VI-AKI患者的转归情况和影响因素,对我院VI-AKI的防治提出建议。方法:回顾性统计分析北京大学第一医院2013年1月—2013年12月所有接受VAN治疗的老年患者的病例。急性肾损伤(acute kidney injury,AKI)的定义采用的是2012 Kidney Disease:Improving Global Outcomes(KDIGO)关于AKI的定义:(1)48 h内血肌酐升高≥0.3 mg·d L-1(≥26.5μmol·L-1)。(2)7 d之内血肌酐升高到≥基础值的1.5倍。VI-AKI的定义是使用万古霉素后或者万古霉素停药7 d之内发生AKI。所有老年患者被分为VI-AKI和NO-AKI组。结果:满足入排标准的186例老年患者中55例发生了VI-AKI,发生率为29.6%。16.1%的患者在用药期间进行了治疗药物浓度监测(therapeutic drug monitoring,TDM)。Logistic回归得出:VAN给药天数[优势比(OR)=1.022;P=0.000]、使用VAN期间合并使用血管加压药(OR=3.139;P=0.009)以及利尿剂(OR=4.262;P=0.001)是VI-AKI的独立危险因素且具有统计学差异。结论:接受VAN治疗的患者TDM比例较低,需要引起重视。对于VAN给药天数较长、使用VAN期间合并使用血管加压药和利尿剂的患者,应该给予更大的重视。
[Abstract]:Objective: to study the incidence and risk factors of vancomycin associated acute renal injury (vancomycin induced acute kidney injury,VI-AKI) in elderly patients after taking vancomycin (vancomycin,VAN). Suggestions on the prevention and treatment of VI-AKI in our hospital were put forward. Methods: all the elderly patients treated with VAN from January 2013 to December 2013 in Peking University first Hospital were analyzed retrospectively. Acute renal injury (acute kidney injury,AKI) is defined using the definition of AKI by 2012 Kidney Disease:Improving Global Outcomes (KDIGO): (1) elevation of serum creatinine 鈮，

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