CAJ | 학술논문

目的：通过监测万古霉素血药浓度，分析血药浓度与疗效、药物不良反应的关系，指导万古霉素在耐甲氧西林葡萄球菌（M RS ）等革兰阳性球菌感染中的合理用药。方法在有指征应用万古霉素的M RS等革兰阳性球菌感染患者中进行该药药物浓度监测。留取血样时间为万古霉素给药至少4个剂量后，在给药前30 min内采血送检谷浓度，给药结束后30 min至1 h内采血送检峰浓度，采用荧光偏振免疫法测定万古霉素血药浓度，同时收集临床资料，进行统计分析。结果25例患者万古霉素血药谷浓度为3．22～50．79 mg／L ，谷浓度＜5 mg／L者3例，5～＜10 mg／L者11例，10～15 mg／L者3例，＞15 mg／L者8例；峰浓度为13．57～60．47 mg／L ，峰浓度＜25 mg／L者14例，25～40 mg／L者7例，＞40 mg／L者4例。感染患者临床好转率为80．0％（20／25）；细菌清除率为87．5％（21／24）。13例患者根据血药浓度监测结果调整用药剂量，其治疗好转率为92．3％（12／13）。4例患者出现肾功能损害。结论万古霉素血药浓度个体差异较大，通过监测血药浓度制定的万古霉素个体化给药方案用于治疗M RS等革兰阳性球菌感染可提高治愈率，减少药物不良反应。
목적：통과감측만고매소혈약농도，분석혈약농도여료효、약물불량반응적관계，지도만고매소재내갑양서림포도구균（M RS ）등혁란양성구균감염중적합리용약。방법재유지정응용만고매소적M RS등혁란양성구균감염환자중진행해약약물농도감측。류취혈양시간위만고매소급약지소4개제량후，재급약전30 min내채혈송검곡농도，급약결속후30 min지1 h내채혈송검봉농도，채용형광편진면역법측정만고매소혈약농도，동시수집림상자료，진행통계분석。결과25례환자만고매소혈약곡농도위3．22～50．79 mg／L ，곡농도＜5 mg／L자3례，5～＜10 mg／L자11례，10～15 mg／L자3례，＞15 mg／L자8례；봉농도위13．57～60．47 mg／L ，봉농도＜25 mg／L자14례，25～40 mg／L자7례，＞40 mg／L자4례。감염환자림상호전솔위80．0％（20／25）；세균청제솔위87．5％（21／24）。13례환자근거혈약농도감측결과조정용약제량，기치료호전솔위92．3％（12／13）。4례환자출현신공능손해。결론만고매소혈약농도개체차이교대，통과감측혈약농도제정적만고매소개체화급약방안용우치료M RS등혁란양성구균감염가제고치유솔，감소약물불량반응。
Objective To analyze the relationship between plasma concentration and efficacy , adverse drug reactions by monitoring vancomycin serum concentrations for appropriately treating the infections caused by methicillin‐resistant Staphylococcus aureus or other gram‐positive cocci .Methods Vancomycin concentration was monitored in the patients with indications for vancomycin therapy .Blood sample was taken after vancomycin was administered for at least 4 doses .The blood sample collected within 30 minutes before dosing was used to determine the trough blood concentration .The samples were taken within 30 minutes to 1 hour after infusion of vancomycin were used to estimate the peak concentration by fluorescence polarization immunoassay .The clinical data were collected at the same time to analyze clinical efficacy and safety .Results Vancomycin trough concentration ranged from 3 .22 mg/L to 50 .79 mg/L in 25 patients ,specifically ,< 5 mg/L in 3 cases ,5‐<10 mg/L in 11 cases ,10‐15 mg/L in 3 cases ,and > 15 mg/L in 8 csaes .Peak concentration ranged from 13 .57 mg/L to 60 .47 mg/L ,specifically ,< 25 mg/L in 14 cases ,25‐40 mg/L in 7 cases ,and > 40 mg/L in 4 cases .The infection was cured in 80 .0% (20/25) of the patients .The gram‐positive cocci were eradicated in 87 .5% (21/24) of the patients .The dosage of vancomycin was adjusted in 13 patients according to the results of blood concentration monitoring .Majority of these patients (12/13 ,92 .3% ) were cured .Renal impairment was observed in 4 patients .Conclusions Vancomycin is safe and effective in treatment of methicillin‐resistant Staphylococcus aureus and other gram‐positive bacterial infections . Vacomycin concentration varies from person to person . Serum concentration monitoring is required to achieve best outcomes and the goal of individualized treatment of vancomycin.