摘要
目的回顾性研究本院骨科术后患者万古霉素治疗药物监测(TDM)结果,分析万古霉素在骨科手术患者体内的药动学特点和相关影响因素。方法收集本院2015至2017年50例骨科患者的61例次万古霉素TDM数据,根据手术至TDM间隔时间分为早期组(术后≤5 d)、中期组(术后6~10 d)和晚期组(术后≥11 d),应用JPKD软件计算药动学参数,应用R3.6.0软件采用多元线性回归及逐步回归的方法对稳态谷浓度(css-min)与其影响因素的关系进行分析。结果骨科术后患者万古霉素css-min为(11.39±5.83)μg·mL^-1,css-min达标(达到10~20μg·mL^-1)的比例为43%,css-min小于10μg·mL^-1占49%。万古霉素css-min与患者年龄、体重、肌酐值及手术至TDM间隔时间(P<0.05,P<0.01)显著相关。万古霉素css-min随手术至TDM间隔时间呈上升趋势,早期组css-min显著低于中、晚期组(P<0.05)。结论本院万古霉素css-min部分未达标可能与术后早期炎症反应有关,应着重在术后早期和中期加强TDM,并注意年龄、体重、肌酐值等相关因素。
AIM To retrospective study the therapeutic drug monitoring(TDM)results of vancomycin blood drug concentration of patients after orthopedic operation in our hospital and analyze the pharmacokinetic characteristics and related factors of vancomycin in patients with orthopedic surgery.METHODS The TDM data of 61 times of vancomycin blood drug concentration in 50 orthopedic patients in our hospital from 2015 to 2017 were collected,which were divided into early group(after operation≤5 days),medium group(after operation 6-10 days)and late group(after operation≥11 days)according to the time of TDM.The pharmacokinetic parameters were calculated by JPKD software,and the relationship between steady-state trough concentration(css-min)and its influencing factors was analyzed by means of multiple linear regression and stepwise regression with R3.6.0 software.RESULTS The css-min of vancomycin in patients after orthopaedic surgery was(11.39±5.83)μg·mL^-1,the proportion of css-min reaching the standard(10-20μg·mL^-1)was 43%,and the proportion of css-min less than 10μg·mL^-1 accounted for 49%.The css-min of vancomycin was significantly correlated with age,body weight,creatinine value and the time between operation and TDM(P<0.05,P<0.01).The css-min of vancomycin showed an upward trend with the interval from operation to TDM,and the css-min in the early group was significantly lower than that in the middle and late group(P<0.05).CONCLUSION The partial failure to meet the standard of vancomycin css-min in our hospital may be related to the early postoperative inflammatory response.The TDM in early and middle period after orthopedic operation should be emphasized,as well as age,weight,creatinine value and other related factors.
作者
徐文俊
陆康生
朱华
孙家艳
李贤文
韩鹏
XU Wen-jun;LU Kang-sheng;ZHU Hua;SUN Jia-yan;LI Xian-wen;HAN Peng(Department of Pharmacy,Northern Jiangsu People’s Hospital/Clinical Medical School of Yangzhou University,Yangzhou JIANGSU 225001,China;Hubei University of Science and Technology,Xianning HUBEI 437100,China)
出处
《中国新药与临床杂志》
CAS
CSCD
北大核心
2020年第10期609-614,共6页
Chinese Journal of New Drugs and Clinical Remedies
基金
扬州市科技发展指导性计划(临床药学)项目(YZCZSYJJ1501)。
关键词
万古霉素
血药浓度
药动学
药物监测
vancomycin
plasma concentration
pharmacokinetics
drug monitoring
作者简介
徐文俊,男,主管药师,硕士,主要从事抗感染临床药学和个体化给药的研究,E-mail:xuwj1989@sina.com;责任作者:朱华,女,主任药师,硕士,主要从事临床药学和医院药学的研究,E-mail:daitutu990201@163.com。
