摘要
目的通过治疗药物监测(TDM)方法对患者伏立康唑用药方案的评价。方法通过搜集2020年住院患者伏立康唑的使用情况,对患者的人口学基本情况、病原菌分布进行统计,并研究血药浓度达标与否的影响因素,包括剂量、负荷剂量、测定时机、性别、Child-Pugh分级,Logistic回归分析法对血药浓度达标的影响因素进行分析。结果纳入的161例患者中,女52例(32.3%)、男109例(67.7%),年龄中位数为52岁(1~88岁),体质量中位数为50 kg(7.2~110 kg);153例进行病原学检查,送检率达95.0%,培养出病原微生物49株,曲霉菌属占63.27%;以血药浓度是否处于达标范围作为因变量,剂量是否按公斤体重(成人静脉负荷剂量6 mg·kg^(-1)、静脉维持剂量4 mg·kg^(-1),儿童和轻体重青少年推荐静脉负荷剂量9 mg·kg^(-1)、静脉维持剂量8 mg·kg^(-1))、是否负荷剂量、测定时机、性别、Child-Pugh评分为自变量,进行Logistic分析,结果显示剂量、负荷剂量、测定时机三者均为TDM是否达标的影响因素。进行TDM患者仅占总数50.3%(81/161)。结论临床上应当结合患者情况、药品说明书及相关指南进一步规范伏立康唑的使用方法,并建议临床通过TDM测定患者的血药浓度,并及时调整给药剂量,为患者提供个体化给药方案。
OBJECTIVE To evaluate the treatment regimens of voriconazole through therapeutic drug monitoring(TDM).METHODS This article collected the hospitalized patients who used voriconazole in 2020,the basic demographic information,distribution of pathogenic bacteria and influence factors of acceptable plasma concentration were analyzed by Logistic regression model,including dose,load dosage,detecting time,sexuality,the grade of Child-Pugh.RESULTS A total of 161 patients were included,52(32.3%)were female and 109(67.7%)were male,with a median age of 52 years(1~88 years)and a median body mass of 50 kg(7.2~110 kg).153 cases were examined for pathogen(95.0%).49 strains of pathogenic microorganisms were cultured including 63.27%aspergillus.The dependent variable is whether the plasma concentration of voriconazole reach the standard range,and the dose based on body weight(adult intravenous load dose of 6 mg·kg^(-1),intravenous maintenance dose of 4 mg·kg^(-1),and intravenous load dose of 9 mg·kg^(-1),intravenous maintenance dose of 8 mg·kg^(-1) for children or lose weight teenager),load dosage,detecting time,sexuality,the various grades of Child-Pugh were the independent variable.Logistic analysis results showed that the dose,loading dose and timing were all the influencing factors of TDM.Whoever,the percentage of patients who underwent TDM was only 50.3%(81/161).CONCLUSION In clinical practice,the usage of voriconazole should be further standardized according to the patients′situation,drug instructions and relevant guidelines,and it′s necessary to measure the plasma concentration of voriconazole through TDM and adjust the dosage of voriconazole to provide individualized drug administration plan for patients.
作者
林逢林
傅新阳
黄晓威
林志强
陈婷婷
LIN Feng-lin;FU Xin-yang;HUANG Xiao-wei;LIN Zhi-qiang;CHEN Ting-ting(Quanzhou Children′s Hospital,Quanzhou 362000,China;Quanzhou First Hospital Affiliated to Fujian Medical University,Quanzhou 362000,China)
出处
《海峡药学》
2022年第6期66-70,共5页
Strait Pharmaceutical Journal
基金
福建医科大学启航基金(项目编号:2018QH1187)
泉州市卫生健康委科研课题(项目编号:20180802)。
关键词
伏立康唑
患者
治疗药物监测
血药浓度
Voriconazole
Patients
Therapeutic drug monitoring
Drug plasma concentration
作者简介
通讯作者:陈婷婷,女,主管药师。
