中国药业
中國藥業
중국약업
CHINA PHARMACEUTICALS
2015年
10期
71-72,73
,共3页
万古霉素%血药谷浓度%临床疗效%肾功能
萬古黴素%血藥穀濃度%臨床療效%腎功能
만고매소%혈약곡농도%림상료효%신공능
vancomycin%blood drug peak concentration%clinical curative effect%renal function
目的：分析万古霉素血药谷浓度与临床疗效及肾功能的相关性，为个体化用药提供参考。方法选择2012年12月至2015年1月医院收治的感染患者62例，监测万古霉素血药谷浓度，定期检测肾功能，治疗后评价临床疗效，记录不良反应发生情况。结果62例患者中，44例（70.97%）血药谷浓度不低于10 mg/L，达到目标值；临床总有效率为83.87%，3种不同谷浓度组[﹤10 mg/L（A组），10~15 mg/L（B组），﹥15 mg/L（C组）]的患者疗效比较，无显著性差异。A组(﹤10 mg/L )的肾功能损伤发生率为11.36%（5/44）；C组(﹥15 mg/L )与A﹢B组(﹤15 mg/L )比较，前组的肾毒性较后组高4倍。结论万古霉素治疗耐甲氧西林金黄色葡萄球菌（MRSA）、耐甲氧西林表皮葡萄球菌（MRSE）和肠球菌等引起的重症感染的临床疗效好，但血药谷浓度高于最低抑菌浓度( MIC )时并不能进一步提高临床疗效，反而会引起肾功能损害，因此在使用过程中应密切监测血药谷浓度。
目的：分析萬古黴素血藥穀濃度與臨床療效及腎功能的相關性，為箇體化用藥提供參攷。方法選擇2012年12月至2015年1月醫院收治的感染患者62例，鑑測萬古黴素血藥穀濃度，定期檢測腎功能，治療後評價臨床療效，記錄不良反應髮生情況。結果62例患者中，44例（70.97%）血藥穀濃度不低于10 mg/L，達到目標值；臨床總有效率為83.87%，3種不同穀濃度組[﹤10 mg/L（A組），10~15 mg/L（B組），﹥15 mg/L（C組）]的患者療效比較，無顯著性差異。A組(﹤10 mg/L )的腎功能損傷髮生率為11.36%（5/44）；C組(﹥15 mg/L )與A﹢B組(﹤15 mg/L )比較，前組的腎毒性較後組高4倍。結論萬古黴素治療耐甲氧西林金黃色葡萄毬菌（MRSA）、耐甲氧西林錶皮葡萄毬菌（MRSE）和腸毬菌等引起的重癥感染的臨床療效好，但血藥穀濃度高于最低抑菌濃度( MIC )時併不能進一步提高臨床療效，反而會引起腎功能損害，因此在使用過程中應密切鑑測血藥穀濃度。
목적：분석만고매소혈약곡농도여림상료효급신공능적상관성，위개체화용약제공삼고。방법선택2012년12월지2015년1월의원수치적감염환자62례，감측만고매소혈약곡농도，정기검측신공능，치료후평개림상료효，기록불량반응발생정황。결과62례환자중，44례（70.97%）혈약곡농도불저우10 mg/L，체도목표치；림상총유효솔위83.87%，3충불동곡농도조[﹤10 mg/L（A조），10~15 mg/L（B조），﹥15 mg/L（C조）]적환자료효비교，무현저성차이。A조(﹤10 mg/L )적신공능손상발생솔위11.36%（5/44）；C조(﹥15 mg/L )여A﹢B조(﹤15 mg/L )비교，전조적신독성교후조고4배。결론만고매소치료내갑양서림금황색포도구균（MRSA）、내갑양서림표피포도구균（MRSE）화장구균등인기적중증감염적림상료효호，단혈약곡농도고우최저억균농도( MIC )시병불능진일보제고림상료효，반이회인기신공능손해，인차재사용과정중응밀절감측혈약곡농도。
Objective To investigate the correlation between the blood vancomycin peak concentration with the clinical effect and renal function to provide reference for personalized medication. Methods Totally 62 patients with infection admitted to our hospital from De-cember 2012 to January 2015 were selected and performed the blood vancomycin peak concentration monitoring. The clinical effect after treatment was evaluated;the renal function was detected at the regular intervals and the occurrence situation of adverse reactions was recorded. Results Among 62 cases of infection,44 cases(70. 97%) had the blood vancomycin peak concentration ≥10 mg/L,which reached the target values;the total effective rate was 83. 87%,the curative effective rates had no statistically significant differences a-mong 3 kinds of different peak concentration groups [﹤ 10 mg/L(group A),10-15 mg/L(group B) and ﹥ 15 mg/L(group C)] . The occurrence rate of renal function damage in the group A was 11. 36%(5/44),comparing the group C (﹥ 15 mg/L ) with the group A﹢B (﹥ 15 mg/L ) ,the renal toxicity in the former group was higher than that in the latter group by 4 times. Conclusion Vancomycin has better clinical effect for treating severe infection caused by methicillin-resistant Staphylococcus aureus(MRSA),methicillin-resistant Staphylococcus epidermidis(MRSE)and enterococcus. But the blood drug peak concentration exceeding the minimal inhibitory concentra-tion(MIC) is unable to further increase the clinical effect,on the contrary could cause the renal function damage. Therefore the blood drug peak concentration should be closely monitored during the drug use process.
