摘要
目的:分析腹膜透析(腹透)相关腹膜炎患者万古霉素血药浓度结果及特点,为腹透患者合理使用万古霉素提供参考。方法:收集2015年1月-2020年12月我院第一医学中心监测万古霉素血药浓度的腹透相关腹膜炎患者的病例资料,回顾性分析万古霉素血药浓度的分布情况、临床治疗方案,探讨血药浓度与治疗方案的关系。结果:万古霉素治疗腹透相关腹膜炎的常用方案为腹腔给药1g·次^(-1),给药间隔以每3~4d一次为主。63例次万古霉素血药浓度结果中,浓度>15μg·mL^(-1)的比例为47.6%。首剂使用万古霉素1g腹腔给药后,首次监测血药浓度<15μg·mL^(-1)的比例为85.7%(18/21),血药浓度均值为(11.0±3.2)μg·mL^(-1);第2次和第3次给药后血药浓度均值分别为(15.7±3.6)μg·mL^(-1)和(18.9±5.2)μg·mL^(-1),血药浓度>15μg·mL^(-1)的比例逐渐提高,前3剂给药后血药浓度均值存在显著性差异(P<0.01)。给药≥3次后监测血药浓度>20μg·mL^(-1)的比例为25.0%(7/28)。结论:腹透相关腹膜炎患者的万古霉素血药浓度存在较大的个体差异。首剂给予万古霉素1g留腹后血药浓度不易达标,建议首剂给予更高的负荷剂量或缩短前2剂的给药间隔;多次给药后,血药浓度升高,存在蓄积风险,应根据血药浓度延长给药间隔或减少剂量。
Objective:To analyze data of therapeutic drug monitoring(TDM)of vancomycin and its characteristics in patients with peritoneal dialysis-associated peritonitis,and provide references for rational use of vancomycin in peritoneal dialysis patients.Methods:Data of patients with peritoneal dialysis-associated peritonitis who used vancomycin and carried out TDM from January 2015 to December 2020 in first medical center of our hospital were retrospectively collected and analyzed to explore the relationship between the blood concentration and the therapeutic regimen.Results:The common dosage regimen of vancomycin for peritoneal dialysis-associated peritonitis was 1 g,intraperitoneal administration,every 3-4 days.There were 63 cases of vancomycin plasma concentration results,among which vancomycin concentration in 47.6%of the cases were more than 15μg·mL^(-1).After the first dose of 1 g vancomycin via the intraperitoneal route,the proportion of the cases whose first vancomycin concentration was less than 15μg·mL^(-1) was 85.7%(18/21),and the mean concentration of them was(11.0±3.2)μg·mL^(-1).The mean blood concentration of vancomycin after the second and the third dose of vancomycin were(15.7±3.6)μg·mL^(-1) and(18.9±5.2)μg·mL^(-1) respectively and the proportion of the cases with vancomycin concentration more than 15μg·mL^(-1) gradually increased.There were statistical significant differences in the mean blood concentration of vancomycin after the first,second and third dose(P<0.01).The proportion of the cases with vancomycin concentration more than 20μg·mL^(-1) after more than 3 doses was 25.0%(7/28).Conclusion:In patients with peritoneal dialysis-associated peritonitis,the blood concentration of vancomycin varied greatly among individuals.The blood concentration would not reach the standard after the first dose of vancomycin 1 g via the intraperitoneal route and it was suggested to give higher loading dose or shorten the interval between the first and the second dose.And the blood concentrations of vanc
作者
蔡乐
张庆涛
谢大洋
王宏
曹雪莹
黄静
朱曼
周建辉
CAI Le;ZHANG Qing-tao;XIE Da-yang;WANG Hong;CAO Xue-ying;HUANG Jing;ZHU Man;ZHOU Jian-hui(Department of Pharmacy,Medical Supplies Center of Chinese PLA General Hospital,Beijing 100853,China;Department of Nephrology,First Medical Center of Chinese PLA General Hospital,Beijing 100853,China)
出处
《中国药物应用与监测》
CAS
2021年第1期13-17,共5页
Chinese Journal of Drug Application and Monitoring
基金
国家重点研发计划课题(2016YFC1103004)。
关键词
腹透相关腹膜炎
万古霉素
治疗药物监测
给药方案
腹腔给药
Peritoneal dialysis-associated peritonitis
Vancomycin
Therapeutic drug monitoring
Dosage regimen
Intraperitoneal administration
