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个体化给药方案对重症患者万古霉素血药谷浓度和肾功能的影响
Effects of individualized dosing regimen on blood trough concentration of vancomycin and renal function in critically ill patients
- 中国药房 2023年34卷第13期 页码：1611-1616
- 作者机构：
1.广州医科大学附属第二医院药学部，广州 510260
2.广州医科大学附属第二医院重症医学科，广州 510260
3.中山大学孙逸仙纪念医院药学部，广州 510030
4.惠阳三和医院药学部，广东 惠州 516211
- 作者简介：
主管药师，硕士。研究方向：临床药学。电话：020-34152376。E-mail：phdloveyou@163.com
主任药师，硕士生导师。研究方向：临床药学、药事管理。电话：020-34152377。E-mail：wangruolun@126.com
- 基金信息：广州市卫生健康科技项目(20211A010061);广东省医学科学技术研究基金项目(B2022028)
DOI：10.6039/j.issn.1001-0408.2023.13.13
中图分类号： R969;R978.1纸质出版日期：2023-07-15，
收稿日期：2022-11-07，
修回日期：2023-06-16，
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彭怀东,张瑞昌,郭诗静等.个体化给药方案对重症患者万古霉素血药谷浓度和肾功能的影响 Δ[J].中国药房,2023,34(13):1611-1616.
PENG Huaidong,ZHANG Ruichang,GUO Shijing,et al.Effects of individualized dosing regimen on blood trough concentration of vancomycin and renal function in critically ill patients[J].ZHONGGUO YAOFANG,2023,34(13):1611-1616.
彭怀东,张瑞昌,郭诗静等.个体化给药方案对重症患者万古霉素血药谷浓度和肾功能的影响 Δ[J].中国药房,2023,34(13):1611-1616. DOI： 10.6039/j.issn.1001-0408.2023.13.13.
PENG Huaidong,ZHANG Ruichang,GUO Shijing,et al.Effects of individualized dosing regimen on blood trough concentration of vancomycin and renal function in critically ill patients[J].ZHONGGUO YAOFANG,2023,34(13):1611-1616. DOI： 10.6039/j.issn.1001-0408.2023.13.13.
摘要
目的
2
考察个体化给药方案对重症患者万古霉素血药谷浓度（以下简称“谷浓度”）和肾功能的影响。
方法
2
临床药师参考相关指南推荐和Vancomycin Calculator软件计算结果，以体质量和肌酐清除率为自变量制定包含了负荷剂量和维持剂量的重症患者万古霉素个体化给药方案。采用回顾性研究方法，选取2018年7月－2021年12月入住广州医科大学附属第二医院重症医学科使用该方案的患者作为试验组，将该科室2015年1月－2018年6月应用万古霉素治疗并行血药浓度监测的患者作为对照组，比较2组患者万古霉素谷浓度的分布差异和用药后急性肾损伤（AKI）的发生率，并分析试验组患者血肌酐的变化情况。
结果
2
试验组纳入197例患者，对照组纳入144例患者。2组患者的性别、年龄、体质量、急性生理学及慢性健康状况评分系统Ⅱ评分、慢性肾功能不全患者占比等临床资料比较，差异均无统计学意义（
P
＞0.05）。2组患者主要的感染部位（包括肺部、尿路、腹腔、血流、中枢神经系统）占比和治疗类型（目标治疗/经验性治疗）占比的差异均无统计学意义（
P
＞0.05）。2组患者万古霉素理想谷浓度（15～20 μg/mL）的达标率和谷浓度＞20 μg/mL的患者占比差异均无统计学意义（
P
＞0.05），而目标谷浓度（10～20 μg/mL）的达标率和谷浓度＜10 μg/mL的患者占比差异均有统计学意义（
P
＜0.05）。试验组合并慢性肾功能不全患者目标谷浓度的达标率显著高于对照组（
P
＜0.05）。2组患者用药后AKI的发生率、万古霉素相关AKI的发生率差异均无统计学意义（
P
＞0.05）。用药时间≥7 d的试验组患者在用药第7天时的血肌酐水平较用药第3天时显著升高（
P
＜0.05）。
结论
2
该个体化给药方案能够提高重症患者尤其是合并慢性肾功能不全的重症患者万古霉素首次规范监测时目标谷浓度的达标率，且与既往经验性用药相比不增加重症患者肾损伤的风险。
Abstract
OBJECTIVE
2
To investigate the effects of individualized dosing regimen on blood trough concentration of vancomycin and renal function in critically ill patients.
METHODS
2
According to relevant guidelines and the results of Vancomycin Calculator， clinical pharmacists formulated an individualized dosing regimen of vancomycin including loading dose and maintenance dose for critically ill patients based on the two independent variables of body weight and creatinine clearance rate. Using the method of retrospective study， patients who were admitted to the department of intensive care unit （ICU） of the Second Affiliated Hospital of Guangzhou Medical University and used the regimen from July 2018 to December 2021 were selected as the trial group， and patients who were treated with vancomycin and received blood drug concentration monitoring in ICU from January 2015 to June 2018 were recruited in the control group. The difference in trough concentration distribution and the incidence of acute kidney injury （AKI） after medication were compared between the two groups， the change of serum creatinine before and after medication in the trial group was analyzed.
RESULTS
2
Totally 197 patients were included in the trial group and 144 patients were in the control group. There was no significant difference between the two groups in the clinical information （gender， age， body weight， acute physiology and chronic health evaluation Ⅱ score， the proportion of patients with renal insufficiency， etc.） （
P
＞0.05）. The proportions of major infection sites （including lung， urinary， abdominal， blood and central nervous system） and treatment type （target or empirical treatment） also had no significant difference between the two groups （
P
＞0.05）. There was no significant difference in the attainment rate of ideal trough concentration （15-20 μg/mL） and the proportion of patients with trough concentration ＞20 μg/mL between the two groups （
P
＞0.05）， while the attainment rate of target trough concentration （10-20 μg/mL） and the proportion of patients with trough concentration ＜10 μg/mL were significantly different between the two groups （
P
＜0.05）. The attainment rate of target trough concentration in patients with chronic renal insufficiency in trial group was significantly higher than that in control group （
P
＜0.05）. There was no significant difference in the incidence of AKI and vancomycin-associated AKI between the two groups （
P
＞0.05）. In the trial group with medication duration ≥7 days ， the level of serum creatinine on the 7th day of treatment was increased significantly， compared with that on the 3rd day of treatment （
P
＜0.05）.
CONCLUSIONS
2
This individualized dosing regimen can improve the attainment rate of target trough concentration of vancomycin in critically ill patients， especially those with chronic renal insufficiency， during the first standardized monitoring， and not increase the risk of renal injury compared with previous empirical medication.
关键词
万古霉素重症患者个体化给药方案治疗药物监测血药谷浓度肾功能
Keywords
critically ill patientsindividualized dosing regimentherapeutic drug monitoringblood trough concentrationrenal function
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