中国医药
中國醫藥
중국의약
China Medicine
2015年
10期
1542-1544
,共3页
盐酸去甲万古霉素%脑脊液%药动学%临床疗效%相关性
鹽痠去甲萬古黴素%腦脊液%藥動學%臨床療效%相關性
염산거갑만고매소%뇌척액%약동학%림상료효%상관성
Norvancomycin%Cerebrospinal fluid%Pharmacokinetics%Clinical curative effect%Correlation
目的 探讨盐酸去甲万古霉素的脑脊液药动学与临床疗效的相关性.方法 选择2014年2-12月北京市大兴区人民医院耐甲氧西林金黄色葡萄球菌感染青年患者40例作为研究对象,所有患者接受单剂注射用盐酸去甲万古霉素0.8g静脉滴注,测定与计算脑脊液中去甲万古霉素的药物浓度与药动学情况,并与临床疗效进行相关性分析.结果 去甲万古霉素的脑脊液溶液高浓度标准曲线范围(64±4) mg/L,线性回归方程Y=8.371 3X±6.845 7,r=0.999 1,日内相对标准偏差≤4.58％,日间相对标准偏差≤5.38％,周间相对标准偏差≤7.93％.患者静脉滴注去甲万古霉素0.8g结束后即刻脑脊液药物浓度为(43.6 ±7.0) mg/L,1h内降至峰浓度的50％以下,为(22.9 ±4.2)mg/L,12h和24 h后的平均血药浓度分别为(6.5±1.3) mg/L和(3.1±0.9) mg/L,36 h全部患者的脑脊液药物浓度均高于最低检测浓度(1.0 mg/L),平均(1.8±0.4) mg/L.药物的半衰期、表观分布容积、药时曲线下面积、药物总清除率与24 h肾清除率分别为(0.35±0.08)h、(9.9±2.2)L、(198 ±20) mg/L·h、(87±22) ml/min、(76±17) ml/min.治疗后40例患者总有效率为90.0％ (36/40),治疗过程中无不良反应发生.线性回归方程分析显示去甲万古霉素的药时曲线下面积与药物总清除率为影响临床疗效的主要危险因素(比值比=1.893、2.154,P＜0.05).结论 盐酸去甲万古霉素的药动学参数与临床疗效有明显相关性,在临床使用中应进行脑脊液药物浓度与药动学监测,据此调整给药方案,从而改善患者预后.
目的 探討鹽痠去甲萬古黴素的腦脊液藥動學與臨床療效的相關性.方法 選擇2014年2-12月北京市大興區人民醫院耐甲氧西林金黃色葡萄毬菌感染青年患者40例作為研究對象,所有患者接受單劑註射用鹽痠去甲萬古黴素0.8g靜脈滴註,測定與計算腦脊液中去甲萬古黴素的藥物濃度與藥動學情況,併與臨床療效進行相關性分析.結果 去甲萬古黴素的腦脊液溶液高濃度標準麯線範圍(64±4) mg/L,線性迴歸方程Y=8.371 3X±6.845 7,r=0.999 1,日內相對標準偏差≤4.58％,日間相對標準偏差≤5.38％,週間相對標準偏差≤7.93％.患者靜脈滴註去甲萬古黴素0.8g結束後即刻腦脊液藥物濃度為(43.6 ±7.0) mg/L,1h內降至峰濃度的50％以下,為(22.9 ±4.2)mg/L,12h和24 h後的平均血藥濃度分彆為(6.5±1.3) mg/L和(3.1±0.9) mg/L,36 h全部患者的腦脊液藥物濃度均高于最低檢測濃度(1.0 mg/L),平均(1.8±0.4) mg/L.藥物的半衰期、錶觀分佈容積、藥時麯線下麵積、藥物總清除率與24 h腎清除率分彆為(0.35±0.08)h、(9.9±2.2)L、(198 ±20) mg/L·h、(87±22) ml/min、(76±17) ml/min.治療後40例患者總有效率為90.0％ (36/40),治療過程中無不良反應髮生.線性迴歸方程分析顯示去甲萬古黴素的藥時麯線下麵積與藥物總清除率為影響臨床療效的主要危險因素(比值比=1.893、2.154,P＜0.05).結論 鹽痠去甲萬古黴素的藥動學參數與臨床療效有明顯相關性,在臨床使用中應進行腦脊液藥物濃度與藥動學鑑測,據此調整給藥方案,從而改善患者預後.
목적 탐토염산거갑만고매소적뇌척액약동학여림상료효적상관성.방법 선택2014년2-12월북경시대흥구인민의원내갑양서림금황색포도구균감염청년환자40례작위연구대상,소유환자접수단제주사용염산거갑만고매소0.8g정맥적주,측정여계산뇌척액중거갑만고매소적약물농도여약동학정황,병여림상료효진행상관성분석.결과 거갑만고매소적뇌척액용액고농도표준곡선범위(64±4) mg/L,선성회귀방정Y=8.371 3X±6.845 7,r=0.999 1,일내상대표준편차≤4.58％,일간상대표준편차≤5.38％,주간상대표준편차≤7.93％.환자정맥적주거갑만고매소0.8g결속후즉각뇌척액약물농도위(43.6 ±7.0) mg/L,1h내강지봉농도적50％이하,위(22.9 ±4.2)mg/L,12h화24 h후적평균혈약농도분별위(6.5±1.3) mg/L화(3.1±0.9) mg/L,36 h전부환자적뇌척액약물농도균고우최저검측농도(1.0 mg/L),평균(1.8±0.4) mg/L.약물적반쇠기、표관분포용적、약시곡선하면적、약물총청제솔여24 h신청제솔분별위(0.35±0.08)h、(9.9±2.2)L、(198 ±20) mg/L·h、(87±22) ml/min、(76±17) ml/min.치료후40례환자총유효솔위90.0％ (36/40),치료과정중무불량반응발생.선성회귀방정분석현시거갑만고매소적약시곡선하면적여약물총청제솔위영향림상료효적주요위험인소(비치비=1.893、2.154,P＜0.05).결론 염산거갑만고매소적약동학삼수여림상료효유명현상관성,재림상사용중응진행뇌척액약물농도여약동학감측,거차조정급약방안,종이개선환자예후.
Objective To analyze the correlation between pharmacokinetics of norvancomycin in cerebrospinal fluid (CSF) and clinical efficacy.Methods Totally 40 young patients suffering from methicillin resistant staphylococcus aureus infection from February to December 2014 were given a single dose of vancomycin intravenous infusion (0.8 g).The norvancomycin drug concentration in CSF was measured;the pharmacokinetic data were calculated and their correlations with the efficacy were analyzed.Results The high vancomycin concentration range of the standard curve in CSF solution was (64 ± 4) mg/L;the linear regression equation was Y=8.371 3X + 6.845 7,r =0.999 1;the relative standard deviation in intra-day,inter-day and inter-week was ≤4.58％,≤ 5.38％,≤ 7.93％,respectively.The norvancomycin concentration in CSF was (43.6 ± 7.0) mg/L immediately after intravenous use of the drug,and it decreased to (22.9 ±4.2) mg/L after 1 hour,(6.5 ± 1.3) mg/L after 12 hours and (3.1 ± 0.9) mg/L after 24 hours;the drug concentration in CSF after 36 hours was lower than the value of detectable concentration in all patients.The half-life,apparent volume of distribution,area under the concentration time curve (AUC),drug total clearance rate and 24 h renal clearance rate were (0.35 ±0.08) h,(9.9 ±2.2) L,(198 ±20) mg/L · h,(87 ±22) ml/min and (76 ± 17) ml/min,respectively.The total efficiency was 90.0％ (36/40) and no adverse reactions occurred.Linear regression analysis showed that AUC and drug total clearance rate were the main influence factors of clinical curative effect (OR =1.893,2.154;P ＜ 0.05).Conclusion The pharmacokinetic parameters of vancomycin in CSF are related to clinical efficacy;pharmacokinetic monitoring of vancomycin concentration in CSF should be applied to guild the adjustment of dosage regimen to improve the prognosis.
