CAJ | 학술논문

目的探讨危重患者万古霉素血药谷浓度与肾损害的相关性。方法采用前瞻性随机对照方法，将2012-11～2013-12兰州大学第二医院内科ICU使用万古霉素治疗的患者随机分为低谷浓度组（5～10 mg/L）与高谷浓度组（10～20 mg/L），比较两组患者临床有效率、肾损害发生率，并分析肾损害发生的危险因素。结果83例患者中低谷浓度组36例，临床有效率77.8％；高谷浓度组47例，临床有效率95．7％，两组比较差异有统计学意义（P＜0．05）；两组患者肾损害发生率比较差异无统计学意义（5．5％ vs 8．5％，P＝0．394）；肾损害发生的危险因素包括年龄（比值比＝1．17，95％CI 1．01～1．36）、APACHEⅡ评分（比值比＝1．48，95％CI 1．02～2．14）、疗程≥14 d（比值比＝1．15，95％CI 1．02～1．31）及合并使用肾损害药物（比值比＝1．38，95％CI 1．03～1.85）。结论高谷浓度万古霉素可明显提高疗效，且肾损害发生率未明显增加；危重患者中出现万古霉素相关肾损害可能与年龄、APACHEⅡ评分、疗程≥14 d及合并使用其他肾毒性药物等因素相关。
목적탐토위중환자만고매소혈약곡농도여신손해적상관성。방법채용전첨성수궤대조방법，장2012-11～2013-12란주대학제이의원내과ICU사용만고매소치료적환자수궤분위저곡농도조（5～10 mg/L）여고곡농도조（10～20 mg/L），비교량조환자림상유효솔、신손해발생솔，병분석신손해발생적위험인소。결과83례환자중저곡농도조36례，림상유효솔77.8％；고곡농도조47례，림상유효솔95．7％，량조비교차이유통계학의의（P＜0．05）；량조환자신손해발생솔비교차이무통계학의의（5．5％ vs 8．5％，P＝0．394）；신손해발생적위험인소포괄년령（비치비＝1．17，95％CI 1．01～1．36）、APACHEⅡ평분（비치비＝1．48，95％CI 1．02～2．14）、료정≥14 d（비치비＝1．15，95％CI 1．02～1．31）급합병사용신손해약물（비치비＝1．38，95％CI 1．03～1.85）。결론고곡농도만고매소가명현제고료효，차신손해발생솔미명현증가；위중환자중출현만고매소상관신손해가능여년령、APACHEⅡ평분、료정≥14 d급합병사용기타신독성약물등인소상관。
Objective To explore the relationship between vancomycin trough concentrations and incidence of nephrotoxicity in critically ill patients.Methods This was a prospective randomized controlled trial.Hospitalized patients who received a course of vancomycin therapy between November 2012 and December 2013 in MICU of Lanzhou University Second Hospital were prospectively studied. Patients were randomly divided into low trough concentration group ( 5 ~10 mg/L ) and high trough concentration group (10~20 mg/L) .The effective rate and incidence of nephrotoxicity were compared, and the incidence of nephrotoxicity associated with the different vancomycin trough concentrations, in addition other risk factors for development of nephrotoxicity were analyzed.Results Of the 83 patients in the study, 36 in the group of low trough concentration (5~10 mg/L) and 47 in the group of high trough concentration (10~20 mg/L),there were significant differences between two groups in clinical response (77.8%vs.95.7%, P<0.05).No significant difference was observed between two groups in toxicity (5.5% vs.8.5%, P =0.394).Independent predictors of vancomycin -induced nephrotoxicity includedage (OR=1.17;95%CI 1.01~1.36), APACHEⅡ score (OR=1.48;95%CI 1.02-2.14), duration of vancomycin therapy≥14 days (OR=1.15;95%CI 1.02~1.31), and concomitant other nephrotoxic agents (OR=1.38; 95%CI 1.03 -1.85).Conclusion The higher vancomycin trough concentration has better clinical response compared with the lower trough concentration.Moreover incidence of nephrotoxicity is not apparent increase concomitantly. Age, APACHEⅡscore, duration of vancomycin therapy≥14 days, and concomitant other nephrotoxic agents are probably risk factors for vancomycin-induced nephrotoxicity.