24)的影響。方法 回顧分析2015年1月-2017年9月入住廣州醫(yī)科大學(xué)附屬第二醫(yī)院重癥醫(yī)學(xué)科的319例臨床懷疑或證實(shí)存在嚴(yán)重的革蘭陽(yáng)性球菌感染的重癥患者,根據(jù)醫(yī)囑中是否使用萬(wàn)古霉素25 mg/kg體質(zhì)量的負(fù)荷劑量,將患者分為普通用藥組和負(fù)荷劑量組,計(jì)算萬(wàn)古霉素的AUC24>400為目標(biāo)AUC24。通過(guò)多元線性逐步回歸法和Logistic回歸進(jìn)行多因素分析。生存分析采用Kaplan-Meier法進(jìn)行分析。結(jié)果 負(fù)荷劑量組納入患者68例,普通用藥組納入患者156例。普通用藥組AUC24明顯低于負(fù)荷劑量組,兩者比較差異具有顯著意義(P<0.001);負(fù)荷劑量和普通用藥組患者住院死亡率存在差異,分別為20.59%、35.26%。將多因素納入Logistic回歸方程分析后發(fā)現(xiàn),使用萬(wàn)古霉素負(fù)荷劑量患者的死亡率為普通用藥組的47.80%。Kaplan-Meier生存分析提示兩者生存曲線比較差異存在顯著差異(P=0.02)。結(jié)論 用萬(wàn)古霉素25 mg/kg負(fù)荷劑量給藥方案能有效提高臨床懷疑或證實(shí)存在嚴(yán)重的革蘭陽(yáng)性球菌感染重癥感染患者萬(wàn)古霉素AUC24的水平和達(dá)標(biāo)率,同時(shí)降低ICU住院死亡率。;Objective To evaluate the effect of vancomycin loading dose on the area under 24-hour curve (AUC24) of vancomycin in critical patients. Methods A retrospective analysis was made on 319 patients with suspected or confirmed severe Gram-positive coccal infections who were admitted to Department of Intensive Care Unit, The Second Affiliated Hospital of Guangzhou Medical University from January 2015 to September 2017. According to the loading dose of vancomycin with 25 mg/kg body weight, patients were divided into general administration group and loading dose group. The target AUC24 was set as AUC24 > 400. Kaplan-Meier method was used for survival analysis. Multivariate linear stepwise regression and logistic regression were used for multivariate analysis. Results There were 68 patients in loading dose group and 156 patients in general administration group. AUC24 of general administration group were lower than that of loading dose group with significant difference (P < 0.001). There were differences in ICU mortality between two groups, which were 20.59% and 35.26%, respectively. Multivariate logistic regression analysis showed that the mortality rate of loading dose group was 47.80% compared with general administration group. Kaplan-Meier survival analysis indicated that there was significant difference in survival curve between two groups (P=0.02). Conclusion Vancomycin dosages with loading dose can improve the levels of vancomycin AUC24 and the rate of reaching the standard in patients with suspected or confirmed severe Gram-positive coccal infections and reduce the in-hospital mortality in ICU."/> 24;survival analysis"/>

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首頁(yè) > 過(guò)刊瀏覽>2020年第35卷第2期 >2020,35(2):340-344. DOI:10.7501/j.issn.1674-5515.2020.02.031
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萬(wàn)古霉素負(fù)荷劑量對(duì)重癥患者24小時(shí)藥時(shí)曲線下面積(AUC24)的影響

Effect of loading dose on vancomycin area under 24-hour curve (AUC24) in critical patients

發(fā)布日期:2020-03-07