腹透相关性腹膜炎腹腔给予万古霉素血药浓度的特点及与疗效的关系
杭永付, 徐德宇, 薛领, 胡坤, 边诣聪, 沈艳萍, 黄晨蓉, 杨静, 卢国元, 沈蕾, 乔青, 沙文刚, 李明,周玲, 缪丽燕
中国药学杂志 ›› 2019, Vol. 54 ›› Issue (12) : 1031-1034.
腹透相关性腹膜炎腹腔给予万古霉素血药浓度的特点及与疗效的关系
Characteristics of Vancomycin Blood Concentrations after Intraperitoneal Administration and Its Relationship with Efficacy in PDRP Patients with Peritoneal Dialysis-related Peritonitis
目的 分析我院腹透相关腹膜炎(PDRP)万古霉素血药浓度结果,探讨与疗效的相关性。方法 回顾性收集2015年8月至2018年4月入住我院使用万古霉素的腹透相关腹膜炎46例次患者的资料,按给药方案分为万古霉素1 g,q3d、q4d、q5d3组,分析各万古霉素方案首次给药血药浓度水平、多次给药的浓度分布特性及与转归的相关性。结果 ①万古霉素1 g,q3d方案首次谷浓度均值为(10.51±2.79)mg·L-1;1 g,q4d方案首次谷浓度均值(6.78±1.58)mg·L-1;1 g,q5d方案首次谷浓度均值(6.68±1.68)mg·L-1,q3d组与q4d和q5d组有统计学差异(P<0.01);②万古霉素1 g,q3d方案3次给药后谷浓度(16.15±4.79)mg·L-1,1 g,q4d方案;第2次给药后谷浓度(10.20±2.0)mg·L-1;1 g,q5d方案第2次给药后谷浓度均值(9.49±3.24)mg·L-1,3组较前均升高且统计学有显著差异(P<0.01);③以10 mg·L-1为界分为谷浓度≥10 mg·L-1与<10 mg·L-1组,两组之间疗效无显著差异(P>0.05);以15 mg·L-1为界分为谷浓度≥15 mg·L-1与<15 mg·L-1组,两组之间疗效也无差异(P>0.05)。结论 PDRP患者万古霉素腹腔后血药浓度存在较大个体化差异,多次给药后存在蓄积,建议万古霉素1 g,q3d作为初始经验给药方案,监测血药浓度且谷浓度维持在10 mg·L-1以上。
OBJECTIVE To evaluate the relationship between serum vancomycin level and efficacy in peritoneal dialysis-related peritonitis(PDRP) patients by analyzing our hospital′s data. METHODS Forty-six PDRP patients admitted in our hospital from August 2015 to April 2018 were collected, then divided into three groups by different regimens(1 g q3d, 1 g q4d, 1 g q5d), the probability of target attainment of the first trough concentration and those after several administrations, the characteristics of distribution of vancomycin serum level and the relation with efficacy were analyzed. RESULTS The first trough concentrations of 1 g q3d, 1 g q4d and 1 g q5d were (10.51±2.79), (6.78±1.58) and (6.68±1.68) mg·L-1 respectively, with statistical difference between 1 g q3d regimen and 1 g q4d, 1 g q5d (P<0.01). The trough concentration after the 3rd administration of 1 g q3d regimen was (16.15±4.79) mg·L-1, the trough concentration after the 2nd administration of 1 g q4d regimen was (10.20±2.0) mg·L-1, and the trough concentration after the 2nd administration of 1 g q5d regimen was (9.49±3.24) mg·L-1. The serum vancomycin level was increasing after repeated administration with obvious statistical difference among the three regimens(P<0.01). There was no significant difference in the efficacy between concentration<10 mg·L-1 and that ≥10 mg·L-1 or concentration <15 mg·L-1 and that ≥15 mg·L-1(P>0.05). CONCLUSION There is significant inter-individual differences of serum vancomycin level in PDRP patients after IP administration, and vancomycin is accumulated in body after repeated administration. It is suggested to monitor the serum vancomycin concentration and the trough concentration kept above 10 mg·L-1.
腹透相关性腹膜炎 / 万古霉素 / 谷浓度 / 疗效 {{custom_keyword}} /
peritoneal dialysis-related peritonitis / vancomycin / trough concentration / efficacy {{custom_keyword}} /
国家临床重点专科(临床药学)建设项目资助;苏州市科技局医疗卫生应用基础研究项目资助(SYSD2016146)
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