2019 年第 5 期 第 14 卷

医院2015—2017年120例患者万古霉素血药浓度监测结果回顾分析

Retrospective analysis of blood concentration monitoring results of vancomycin in 120 patients from 2015 to 2017

作者：陈婷马婧黄晓会陈霁晖祁佳张春

英文作者：

单位：200092上海交通大学医学院附属新华医院药学部

英文单位：

关键词：血药浓度监测；万古霉素；个体化用药

英文关键词：

• 摘要：

• 【摘要】目的    对万古霉素血药浓度监测结果进行分析，促进临床合理化个体化用药。方法    收集上海交通大学医学院附属新华医院2015—2017年使用万古霉素并测定万古霉素血药浓度120例患者的临床资料，回顾性分析万古霉素血药浓度变化情况。结果    120例患者用药后峰浓度平均值为（32±12） mg/L，最小峰浓度为14.67 mg/L，最大峰浓度为93.64 mg/L，其中峰浓度<25 mg/L者35例（29.2%），在25～40 mg/L者 63例（52.5%），>40 mg/L者22例（18.3%）。平均谷浓度为（16±8） mg/L，最小谷浓度为2.71 mg/L，最大谷浓度为42.19 mg/L。按照《万古霉素临床应用中国专家共识（2011版）》，谷浓度范围应在15～20 mg/L，本研究120例中，有66例（55.0%）谷浓度<15 mg/L，有23例（19.2%）谷浓度在15～20 mg/L之间，有31例（25.8%）>20 mg/L。 结论本院万古霉素血药浓度监测力度不足，应加大宣传，提高临床医师送检意识，同时临床药师应加强与临床医师的沟通和合作，研究探索适合中国人群的万古霉素治疗窗。

• 【Abstract】Objective    To analyze the monitoring results of vancomycin blood concentration in human and promote the rational and individualized use of vancomycin. Methods    Clinical data of 120 patients who were administered vancomycin and had the blood-drug concentration test were retrospectively analyzed in Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine from 2015 to 2017. Results    Among the 120 patients, the mean peak concentration of vancomycin was （32±12）mg/L; the minimum peak concentration was 14.67 mg/L and the maximum peak concentration was 93.64 mg/L. There were 35 cases（29.2%） having peak vancomycin concentration lower than 25 mg/L, 63 cases（52.5%） of 25-40 mg/L and 22 cases（18.3%） over 40 mg/L. The mean trough concentration of vancomycin was（16±8）mg/L; the minimum trough concentration was 2.71 mg/L and the maximum trough concentration was 42.19 mg/L. According to the therapeutic guidelines, the valid level of vancomycin trough concentration was 15-20 mg/L; among the 120 patients in this research there were 66 cases（55.0%） lower than 15 mg/L, 23 cases（19.2%）of 15-20 mg/L and 31 cases（25.8%） over 20 mg/L. Conclusions    Blood concentration monitoring of vancomycin is insufficient. Communication and cooperation between clinical pharmacists and clinicians should be strengthened to find the rational therapeutic window of vancomycin in Chinese population.