万古霉素在重症急性胰腺炎患者中的药动学研究
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- 英文论文题名：The pharmacokinetics of vancomycin in patients with severe acute pancreatitis
- 论文作者：何娟 ; 毛恩强 ; 景峰 ; 姜慧婷 ; 杨婉花 ; 陈尔真
- 英文论文作者：He Juan ; Mao En-Qiang ; Jing Feng ; Jiang Hui-Ting ; Yang Wan-Hua ; Chen Er-Zhen ; Ruijin Hospital Affiliated to Shanghai JiaoTong University School of Medicine
- 年：2016
- 作者机构：上海交通大学医学院附属瑞金医院药剂科;上海交通大学医学院附属瑞金医院急诊ICU;
- 论文关键词：万古霉素 ; 重症急性胰腺炎 ; 谷浓度 ; Bayesian法 ; 个体化给药
- 英文论文关键词：Vancomycin ; severe acute pancreatitis ; trough concentration ; Bayesian algorithm ; Clinical individualization
- 会议召开时间：2016-09-27
- 会议录名称：中国药学会第十三届青年药学科研成果交流会论文集
- 语种：中文
- 分类号：R969.1
- 学会代码：YYWS
- 会议名称：中国药学会第十三届青年药学科研成果交流会
- 会议地点：中国江西南昌
- 主办单位：中国药学会
- 学会名称：中国药学会
- 页数：5
- 文件大小：790k
- 原文格式：O
- 会议级别：全国
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,p<0.001),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(p<0.001),表观分布容积和清除率显著增加(p<0.01)。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。
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,p<0.001),Vd and CL were 70.3L and7.6 L /h,separately;the serum trough concentration of vancomycin was significantly reduced in early and middle group compared with late group(p<0.001),Vd and CL were significantly increased(p<0.01);Multiple linear regression analysis revealed that there was strong relationship between serum trough concentration and the serum creatinine,average daily dose and the time of vancomycin treatment,and the latter was the most important factor that influencing the trough concentration of vancomycin.Conclusion The serum trough concentration of vancomycin was significantly reduced in SAP patients.And earlier the time of vancomycin treatment,lower the trough concentration.Therefore,the higher dosage regimen was need to ensure the clinical effect,reduce the bacterial resistance.
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,p<0.001),Vd and CL were 70.3L and7.6 L /h,separately;the serum trough concentration of vancomycin was significantly reduced in early and middle group compared with late group(p<0.001),Vd and CL were significantly increased(p<0.01);Multiple linear regression analysis revealed that there was strong relationship between serum trough concentration and the serum creatinine,average daily dose and the time of vancomycin treatment,and the latter was the most important factor that influencing the trough concentration of vancomycin.Conclusion The serum trough concentration of vancomycin was significantly reduced in SAP patients.And earlier the time of vancomycin treatment,lower the trough concentration.Therefore,the higher dosage regimen was need to ensure the clinical effect,reduce the bacterial resistance.
引文
[1]Mayumi T,Ura H,Arata S.et al.Evidence-based clinical practice guideline for acute pancreatitis:proposals[J].J Hepatobiliary Pancreat Surg,2002,9(4):413-422.
[2]何馥倩.黄宗文,郭佳,等.重症急性胰腺炎并发感染的菌谱和耐药性[J].世界华人消化杂志,2007,15(32):3418-3422.
[3]Nordback I,Sand J,Saaristo R,et al.Early treatment with antibiotics reduces the need for surgery in acute necrotizing pancreatitis-a single-center randomized study[J].J Gastrointest Surg,2001,5(2):113-118.
[4]黄洁,孙景勇,毛恩强,等.重症急性胰腺炎细菌感染的菌谱与耐药性分析[J].中国感染与化疗杂志.2009,9(5):372-376
[5]Ahmed A.Negm,Hendrik Poos,Elmar Kruck,Ralf-Peter Vonberg,Dirk Domagk,Ahmed Madisch,Torsten Voigtlander,Michael P.Manns,Jochen Wedemeyer,Tim O.Lankisch.Microbiologic analysis of peri-pancreatic fluid collected during EUS in patients with pancreatitis:impact on antibiotic therapy[J].Gastrointestinal endoscopy.2013,78(2):303-311
[6]Diekma D J,Pfaller M A,Schmitz F J,et a1.Survey of infections due to Staphylococcus species:frequency of occurrence and antimicrobial susceptibility if isolates collected in the United States,Canada,Latin America,Europe,and the Western Pacific region for the SENTRY Antimicrobial Surveillance Program,1997-1999[J].Clin Infect Dis,2001,32(Suppl 2):S114-132.
[7]Liu C,Bayer A,Cosgrove SE et al.Clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children[J].Clin Infect Dis 2011;52:el8-55.
[8]Rybak M,Lomaestro B,Rotschafer JC et al.Therapeutic monitoring of vancomycin in adult patients:a consensus review of the American Society of Health-System Pharmacists,the Infectious Diseases Society of America,and the Society of Infectious Diseases Pharmacists[J].Am J Health Syst Pharm 2009;66:82-98.
[9]陈佰义,管向东,何礼贤等.万古霉素临床应用中国专家共识(2011版)[J].中国新药与临床杂志,2011,30(8):561-572
[10]http://jpkd.pkpd.org.tw
[11]《重症急性胰腺炎诊治指南》.中华外科杂志.2007,45(11期):34-39
[12]Pea F,Viale P,Furlanut M.Antimicrobial therapy in critically ill patients:a review of pathophysiological conditions responsible for altered disposition and pharmacokinetic variability[J].Clin Pharmacokinet 2005;44(10):1009-1034.
[13]Scaglione F,Paraboni L.Pharmacokinetics/pharmacodynamics of antibacterials in the Intensive Care Unit:setting appropriate dosing regimens[J].Int J Antimicrob Agents.2008;32(4):294-301.eng.
[14]杨文雄,康利民,郑永,周雅豪,王啊勇,施红宁,赵应宏,王月秋,黄琼.高渗盐水对重症急性胰腺炎患者血流动力学及血清炎症因子水平的影响[J].中国医药.2012.7(1):55-57
[15]张振宇,顾健,张春燕,安友仲.ICU老年患者液体出入量对万古霉素药代动力学的影响.中国医药.2012.7(1):83-84
[2]何馥倩.黄宗文,郭佳,等.重症急性胰腺炎并发感染的菌谱和耐药性[J].世界华人消化杂志,2007,15(32):3418-3422.
[3]Nordback I,Sand J,Saaristo R,et al.Early treatment with antibiotics reduces the need for surgery in acute necrotizing pancreatitis-a single-center randomized study[J].J Gastrointest Surg,2001,5(2):113-118.
[4]黄洁,孙景勇,毛恩强,等.重症急性胰腺炎细菌感染的菌谱与耐药性分析[J].中国感染与化疗杂志.2009,9(5):372-376
[5]Ahmed A.Negm,Hendrik Poos,Elmar Kruck,Ralf-Peter Vonberg,Dirk Domagk,Ahmed Madisch,Torsten Voigtlander,Michael P.Manns,Jochen Wedemeyer,Tim O.Lankisch.Microbiologic analysis of peri-pancreatic fluid collected during EUS in patients with pancreatitis:impact on antibiotic therapy[J].Gastrointestinal endoscopy.2013,78(2):303-311
[6]Diekma D J,Pfaller M A,Schmitz F J,et a1.Survey of infections due to Staphylococcus species:frequency of occurrence and antimicrobial susceptibility if isolates collected in the United States,Canada,Latin America,Europe,and the Western Pacific region for the SENTRY Antimicrobial Surveillance Program,1997-1999[J].Clin Infect Dis,2001,32(Suppl 2):S114-132.
[7]Liu C,Bayer A,Cosgrove SE et al.Clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children[J].Clin Infect Dis 2011;52:el8-55.
[8]Rybak M,Lomaestro B,Rotschafer JC et al.Therapeutic monitoring of vancomycin in adult patients:a consensus review of the American Society of Health-System Pharmacists,the Infectious Diseases Society of America,and the Society of Infectious Diseases Pharmacists[J].Am J Health Syst Pharm 2009;66:82-98.
[9]陈佰义,管向东,何礼贤等.万古霉素临床应用中国专家共识(2011版)[J].中国新药与临床杂志,2011,30(8):561-572
[10]http://jpkd.pkpd.org.tw
[11]《重症急性胰腺炎诊治指南》.中华外科杂志.2007,45(11期):34-39
[12]Pea F,Viale P,Furlanut M.Antimicrobial therapy in critically ill patients:a review of pathophysiological conditions responsible for altered disposition and pharmacokinetic variability[J].Clin Pharmacokinet 2005;44(10):1009-1034.
[13]Scaglione F,Paraboni L.Pharmacokinetics/pharmacodynamics of antibacterials in the Intensive Care Unit:setting appropriate dosing regimens[J].Int J Antimicrob Agents.2008;32(4):294-301.eng.
[14]杨文雄,康利民,郑永,周雅豪,王啊勇,施红宁,赵应宏,王月秋,黄琼.高渗盐水对重症急性胰腺炎患者血流动力学及血清炎症因子水平的影响[J].中国医药.2012.7(1):55-57
[15]张振宇,顾健,张春燕,安友仲.ICU老年患者液体出入量对万古霉素药代动力学的影响.中国医药.2012.7(1):83-84