本文選題：萬古霉素　切入點：腎毒性　出處：《現(xiàn)代中西醫(yī)結(jié)合雜志》2016年29期

【摘要】：目的探討萬古霉素血藥濃度與腎毒性之間的關(guān)系,對患者預(yù)后的影響及增加腎毒性的危險因素。方法選擇符合標準的住院期間靜脈用萬古霉素且監(jiān)測血藥濃度的患者105例,收集患者性別、年齡、感染部位、科室分布情況、病原學(xué)檢查情況等資料,統(tǒng)計萬古霉素谷濃度、峰濃度及不同谷濃度下腎毒性發(fā)生率;根據(jù)萬古霉素用藥期間是否出現(xiàn)腎毒性分為腎損傷組與非損傷組,比較2組萬古霉素谷濃度、峰濃度,用藥前后血肌酐值、肌酐清除率,合并疾病情況,同時使用抗生素及其他藥物情況。結(jié)果 105例患者共行血藥濃度監(jiān)測125例次,谷濃度20 mg/L與≥20 mg/L的腎毒性發(fā)生率分別為7.57%和46.15%,二者比較差異有統(tǒng)計學(xué)意義(P0.05)。腎損傷組的谷濃度中位數(shù)達26.1 mg/L,非損傷組中位數(shù)13.2 mg/L,腎損傷組明顯高于非損傷組(P0.05);腎損傷組合并糖尿病比例和使用升壓藥比例均明顯高于非損傷組(P均0.05)。革蘭陽性菌感染者40例經(jīng)萬古霉素治療后,臨床有效率為57.5%;細菌學(xué)清除率32.5%,未清除率20%,病原菌轉(zhuǎn)為革蘭陰性菌3例,未復(fù)查16例。結(jié)論高的萬古霉素谷濃度可增加腎毒性的風(fēng)險,谷濃度≥20mg/L腎毒性發(fā)生率明顯增加;若患者合并糖尿病或使用升壓藥,將增加腎毒性的風(fēng)險。
[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.

【作者單位】： 上海交通大學(xué)醫(yī)學(xué)院附屬新華醫(yī)院;
【基金】：上海市科學(xué)技術(shù)委員會基金項目(13ZR1426500) 2013—2014年度國家臨床重點專科建設(shè)項目
【分類號】：R969

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