万古霉素连续输注治疗革兰氏阳性菌感染与肾毒性的风险显着降低有关.docVIP

万古霉素(，陈尔真2( (上海交通大学医学院附属瑞金医院 上海 200025) 『摘要』 目的 对重症急性胰腺炎(SAP)患者使用万古霉素后的血药浓度及其药代动力学进行研究，并对万古霉素血药浓度的影响因素进行分析。方法 收集SAP患者使用万古霉素的稳态谷浓度测定数据(SAP组)；根据万古霉素的用药时间不同，将其谷浓度数据进一步分组，SAP发病21天内测得的浓度 (早期组)，发病22-28天内测得的浓度 (中期组)以及发病28天以上的浓度(晚期组)。结果 共收集到33例患者共计80例次万古霉素谷浓度数据。与万古霉素标准治疗浓度(15mg/L)相比，SAP组浓度显著降低 (8.3mg/L, p0.001)，Bayesian法估算的万古霉素表观分布容积为70.3L，清除率为7.6L/h；早期组和中期组的浓度较晚期组的浓度显著降低 (p0.001)，表观分布容积和清除率显著增加 (p0.01)。回归分析显示，万古霉素谷浓度不仅与患者的血清肌酐清除率，平均日剂量相关，而且与万古霉素的用药时间显著相关。结论 SAP患者的万古霉素谷浓度显著降低，且万古霉素的用药时间越早，浓度越低。在SAP治疗早期，应给与较高剂量的万古霉素以保证临床治疗效果，减少细菌耐药。 [关键词] 万古霉素；重症急性胰腺炎；谷浓度；Bayesian法；个体化给药 The pharmacokinetics of vancomycin in patients with severe acute pancreatitis He Juan1，Mao En-Qiang2#, Jing Feng2, Jiang Hui-Ting1, Yang Wan-Hua1*, Chen Er-Zhen2* （Ruijin Hospital Affiliated to Shanghai JiaoTong University School of Medicine） Abstract Objective To evaluate the serum trough concentration and the pharmacokinetics of vancomycin in patients with severe acute pancreatitis (SAP), and the regression analysis was made for the factors influencing vancomycin concentration. Method Steady-state trough concentrations of vancomycin from patients with SAP concomitantly with G+ infection (SAP group) between January 2010 and December 2013 were collected. The SAP group was further divided into early group, middle group and late group, according to the time of vancomycin treatment. Result 33 patients were collected which contains 80 times trough concentrations of vancomycin. Compared with the standard concentration (15mg/L) of vancomycin, the serum trough concentration of vancomycin was significantly reduced in SAP group (8.3mg/L, p0.001), Vd and CL were 70.3L and 7.6 L /h, separately; the serum trough concentration of vancomycin was significantly reduced in early and middle group compared with late group (p0.001)，Vd and CL were significantly increased (p0.01)；Multiple linear regression analysis revealed that there was strong relationship between serum trough concentration and the serum creatinine, average da