摘要
目的:评估心脏病患者的心脏功能及肾功能对万古霉素清除率的影响。方法:对303例患者在使用了万古霉素注射1 h后以及下一次用药前的血清浓度进行检测,同时检测患者左心室射血分数(LVEF)。根据2次检测结果计算万古霉素的药动学参数。结果:LVEF<50%(69例)的患者以及50%≤LVEF<75%的患者(108例),其万古霉素的清除率显著低于LVEF≥75%(126例)的患者[万古霉素清除率分别为(2.39±0.94)和(2.78±0.98)L·h-1 vs(3.51±1.05)L·h-1 P<0.001或P<0.01]。万古霉素的清除率不仅与LVEF<50%(r=0.827)和50%≤LVEF<75%(r=0.774)患者的肌酐清除率的估计值高度相关,同时与肌酐清除率(Ccr)<60 ml·min-1患者的左心室射血分数有关(r=0.645)。Logisitic回归分析提示Ccr、LVEF和体质量是万古霉素清除率的重要的独立变量(r2=0.650)。结论:万古霉素清除率随着LVEF和Ccr的降低而降低。提示万古霉素清除率除受到患者肾功能影响外还受到患者心脏功能的影响,因此在临床使用中需要参考患者的Ccr和LVEF数值来调整万古霉素的用量。
OBJECTIVE To evaluate the influences of cardiac and renal functions on vancomycin（aglycopeptide antibiotic）clearance rate in patients with cardiac diseases.METHODS The study selected 303 patients with left ventricle ejection fraction（LVEF）detected.Vancomycin serum concentration was determined1 hour before and after injection.Pharmacokinetic parameters were estimated based on the above results.RESULTS In patients with LVEF50%（69 cases）and 50%≤LVEF75%（108 cases）,clearance rate of vancomycin was lower than that in patients with LVEF≥75%（126 cases）（2.39±0.94 and 2.78±0.98 L·h^-1 vs.3.51±1.05 L·h^-1;P〈0.001 or P〈0.01）.Vancomycin clearance was not only affected by creatinine clearance rate in patients with LVEF〈50%（r=0.827）and 50%≤LVEF75%（r=0.774）,but also LVEF in patients with a creatinine clearance rate（Ccr）〈60 ml·min^-1.Logistic regression analysis revealed that Ccr,LVEF and body weight were important independent variables（r^2=0.650）for vancomycin clearance.CONCLUSION Vancomycin clearance decreases as LVEF and Ccr decrease.These results suggest that vancomycin clearance rate is not only influenced by renal function,but also by cardiac function.Therefore,we need to adjust vancomycin dose by considering Ccr and LVEF values.
出处
《中国医院药学杂志》
CAS
CSCD
北大核心
2015年第9期825-829,共5页
Chinese Journal of Hospital Pharmacy
基金
河北省卫生厅基金项目(编号:20130416)
关键词
万古霉素
射血分数
肌酐清除率
vancomycinl ejection fractionl creatinine clearance rate
