摘要
目的研究并调查老年人患者万古霉素的血药浓度、肾功能与给药剂量之间的关系,分析万古霉素血药浓度对老年患者肾功能的影响,为老年患者合理应用万古霉素提供参考。方法方便选取2016年1月—2018年1月在该院静脉应用万古霉素的老年住院患者70例,对其给药剂量、肾功能、血清谷浓度等监测结果进行分析。结果该次获得的有效病例共70份,共监测140例次万古霉素的谷浓度,在日剂量为1.0 g时,45.00%的患者万古霉素谷浓度可以维持在是(18.83±1.10)mg/L的有效的治疗浓度范围内,其中谷浓度为10~15 mg/L的占24.6%,15~20 mg/L的占27.7%,给药日剂量与谷浓度差异无统计学意义(χ~2=0.342,P=0.580>0.05)。此外,不同慢性肾功能不全的老年患者的分期的万古霉素谷浓度差异有统计学意义(F=4.088,P=0.009<0.05),慢性肾功能不全的3、4期的老年患者血清谷浓度分别为(20.77±1.95)mg/L和(27.62±1.77)mg/L,均大于20 mg/L。结论该院大多数使用万古霉素的老年患者可以达到有效治疗浓度,日剂量1.0 g为万古霉素相对安全且有效的给药剂量。对于感染耐甲氧西林金葡球菌的老年患者,在通过万古霉素进行治疗时,医护人员必须检测其肾功能。临床上需要结合患者疾病、谷浓度水平等因素调整剂量,对于慢性肾功能不全四期的老年患者应酌情减少日剂量,以防对老年患者造成肾脏功能的损伤。
Objective To study and investigate the relationship between blood drug concentration,renal function and dose of vancomycin in elderly patients,and to analyze the effect of vancomycin blood concentration on renal function in elderly patients,and to rationally apply phytophthora in elderly patients and to provide a reference.Methods A total of 140 elderly inpatients who received vancomycin intravenously in the hospital from January 2016 to January 2018 were convenient enrolled.The monitoring results of dosing dose,renal function and serum trough concentration were analyzed.Results A total of 70 valid cases were obtained,and a total of 140 cases of vancomycin were monitored.At a daily dose of 1.0 g,45.00%of patients had a vancomycin trough concentration of(18.83±1.10)mg/L.Within the effective therapeutic concentration range,24.6%of the cereal concentration was 10 to 15 mg/L,and 27.7%of the 15 to 20 mg/L.There was no significant difference between the daily dose and the trough concentration(χ2=0.342,P=0.580>0.05).In addition,the staging of vancomycin troughs in elderly patients with different chronic renal insufficiency was significantly different(F=4.088,P=0.009<0.05).The serum trough concentrations of elderly patients with stage III and IV of chronic renal insufficiency were(20.77±1.95)mg/L and(27.62±1.77)mg/L,both greater than 20 mg/L.Conclusion Most elderly patients who use vancomycin in the hospital can achieve effective therapeutic concentrations.The daily dose of 1.0 g is a safe and effective dose for vancomycin.For elderly patients infected with methicillin-resistant staphylococcus aureus,medical staff must test their renal function when treated with vancomycin.Clinically,it is necessary to adjust the dose according to factors such as the patient's disease and trough concentration.For elderly patients with chronic renal insufficiency,the fourth dose should be reduced as appropriate to prevent kidney function damage to elderly patients.
作者
朱伟明
李金英
ZHU Wei-ming;LI Jin-ying(Department of Pharmacy,Xiangcheng People's Hospital,Suzhou,Jiangsu Province,215131 China)
出处
《中外医疗》
2018年第29期89-91,共3页
China & Foreign Medical Treatment
关键词
万古霉素
血药浓度
老年患者
肾功能
Vancomycin
Blood concentration
Elderly patients
Renal function
