摘要目的 探讨肾清除率对老年重症肺炎患者体内万古霉素谷浓度的影响.方法 前瞻性非干预观察性研究,纳入2013年11月至2014年10月血清肌酐水平正常的老年重症肺炎患者42例,年龄60 ～ 83岁,中位年龄为74岁,男25例,女17例.测定肾清除率并分析万古霉素的给药方案及血清谷浓度能否达到指南推荐的目标值15 ～20 mg/L.通过一般线性模型分析万古霉素谷浓度的影响因素.结果 万古霉素给药方案为1 g/12 h(17例)、0.5 g/8 h(14例)和0.5g/12 h(11例),相应血清谷浓度中位数及范围为14.9(2.4～28.5)mg/L、16.2 (2.8 ～ 27.8) mg/L和11.6(5.9 ～19.9).万古霉素谷浓度达15 ～ 20 mg/L者10例,低于15 mg/L者22例,高于20 mg/L者10例.一般线性模型分析结果表明,内生肌酐清除率(CCR)和万古霉素每日每公斤体重给药剂量是谷浓度的独立影响因素(均P＜0.05).CCR≥130、70 ～130和＜70 ml·min-1·(1.73 m2)-1者分别为8、22和12例,其中万古霉素谷浓度低于15 mg/L者分别为7、11和4例.结论 万古霉素治疗老年重症肺炎时,患者CCR是谷浓度的独立影响因素,肾清除率增加导致谷浓度低于目标值的风险增加.

abstractsObjective To investigate the effect of renal clearance on serum trough concentration of vancomycin in elderly patients with severe pneumonia.Methods This was a prospective non-interventional study.Forty-two elderly patients with severe pneumonia and normal level of serum creatinine were enrolled from November 2013 to October 2014.The patients included 25 males and 17 females,aged 60-83 years (median 74 years).The renal clearance was measured,and the vancomycin regimen and rate of serum trough concentration achieving guideline-recommended target of 15-20 mg/L were investigated.The factors influencing trough concentration of vancomycin were analyzed using the general linear model.Results The vancomycin regimens were 1 g/ 12 h (17 cases),0.5 g/8 h (14 cases) and 0.5 g/12 h (11 cases),and their median and range of serum concentrations were 14.9 (2.4-28.5) mg/L,16.2 (2.8-27.8) mg/L and 11.6 (5.9-19.9) mg/L,respectively.The guideline-recommended target trough concentration of 15-20 mg/L was reached in only 10 patients,while trough concentration lower than 15 mg/L was found in 22 patients and higher than 20 mg/L in 10 patients.General linear model analysis showed that creatinine clearance rate (CCR) and dose of vancomycin per kilogram of body weight per day were independent influencing factors for trough concentration (both P ＜ 0.05).There were 8 patients with CCR ≥ 130 ml · min-1 · (1.73m2)-1 (augmented renal clearance),22 patients with 70 ≤ CCR ＜ 130 ml · min-1 · (1.73 m2)-1 and 12 patients with CCR ＜ 70 ml · min-1 (1.73 m2)-1,and vancomycin trough concentration below 15 mg/L was found in 7,11 and 4 patients,respectively.Conclusion CCR was an independent influencing factor for trough concentration of vancomycin,and augmented renal clearance increased the risk of subtherapeutic trough concentration of vancomycin.