本文選題：谷濃度 + 萬古霉素��； 參考：《南京大學》2014年碩士論文

【摘要】：第一部分萬古霉素血清谷濃度與急性腎損傷發(fā)生的關系目的探討萬古霉素治療革蘭陽性菌感染過程中血清谷濃度與急性腎損傷發(fā)生之間的關系,并分析萬古霉素相關急性腎損傷(AKI)患者的臨床特點。方法采用前瞻性研究的方法,納入南京大學醫(yī)學院附屬鼓樓醫(yī)院重癥醫(yī)學科2013年2月至2014年1月萬古霉素經驗性或目標性抗感染治療的74例患者,檢測萬古霉素血清谷濃度、血肌酐、肌酐清除率,萬古霉素的用藥劑量及療程。根據(jù)萬古霉素治療期問血肌酐變化,分為AKI組和非AKI組,比較兩組患者首次萬古霉素血清谷濃度、平均谷濃度和最大谷濃度,并進一步納入Logistic多因素回歸分析,對多因素回歸分析有顯著性差異的指標繪制受試者工作特征曲線(ROC)。結果納入研究的74例患者中19例發(fā)生AKI,發(fā)生率為25.7%,其中57.9%AKI患者腎功能恢復。AKI組患者首次萬古霉素谷濃度、平均谷濃度、最大谷濃度均高于非AKI組(均P0.05)。Logistic多因素回歸分析結果顯示,萬古霉素平均谷濃度是引起萬古霉素相關AKI發(fā)生的危險因素(OR=1.133,95%CI,1.029-1.247,P=0.011),萬古霉素平均谷濃度預測AKI的ROC曲線下面積為0.815(95%CI,0.709-0.920),P=0.000,最佳截斷值為17.3mg/L,其敏感度和特異度分別為52.6%,83.6%。結論重癥感染患者萬古霉素治療重癥感染期間可能發(fā)生急性腎損傷,萬古霉素平均谷濃度是引起急性腎損傷的獨立危險因素,平均谷濃度≥17.3mg/L的患者發(fā)生AKI的風險增加。第二部分不同萬古霉素血清谷濃度對重癥感染患者臨床療效的影響目的探討不同水平萬古霉素谷濃度對重癥感染患者臨床療效和細菌清除的影響。方法納入南京大學醫(yī)學院附屬鼓樓醫(yī)院重癥醫(yī)學科2013年2月至2014年1月萬古霉素經驗性或目標性抗感染的74例患者,用藥期間檢測患者萬古霉素血清谷濃度,并監(jiān)測患者用藥前后臨床癥狀、感染相關指標(如體溫、白細胞計數(shù)、中性粒細胞百分比、C反應蛋白、血降鈣素原)、細菌培養(yǎng)和胸部X線的變化。根據(jù)萬古霉素治療結束后的臨床療效和細菌清除情況,分別將患者分為臨床有效組和臨床無效組、細菌清除組和未清除組,分別比較兩組患者的萬古霉素平均谷濃度；并根據(jù)患者萬古霉素平均谷濃度分為四組：A組(10 mg/L)、B組(10-15 mg/L)、C組(15-20 mg/L)、D組(≥20 mg/L),比較四組患者臨床有效率、細菌清除率和住院病死率。結果臨床有效組平均谷濃度高于臨床無效組均(P0.05),不同萬古霉素血清谷濃度患者臨床療效和細菌清除率比較,B、C、D組高于A組,差異具有統(tǒng)計學意義(均P0.05),四組住院病死率無統(tǒng)計學差異。結論萬古霉素治療重癥感染的臨床療效和細菌學療效與血清谷濃度有關,萬古霉素谷濃度≥10mg/L臨床療效和細菌學清除更佳。
[Abstract]:Part I the relationship between the concentration of serum vancomycin and the occurrence of acute renal injury objective to explore the relationship between serum concentration of vancomycin and the occurrence of acute renal injury during the treatment of Gram-positive bacteria infection. The clinical features of vancomycin associated acute renal injury (AKI) were analyzed. Methods from February 2013 to January 2014, 74 patients with vancomycin were enrolled in the Department of intensive Medicine, Gulou Hospital affiliated to Medical College of Nanjing University. The serum concentrations of vancomycin were measured. Serum creatinine, creatinine clearance rate, vancomycin dosage and course of treatment. According to the changes of serum creatinine during vancomycin treatment, the patients were divided into AKI group and non-AKI group. The serum concentration of vancomycin, mean valley concentration and maximum valley concentration were compared between the two groups. The operating characteristic curve (ROC) was drawn for the indexes with significant difference in multivariate regression analysis. Results AKI was found in 19 of 74 patients in the study, with an incidence of 25.7.The mean valley concentration of vancomycin in 57.9 AKI patients was the highest in the AKI group. The maximum valley concentration was higher than that in non-AKI group (P0.05). Logistic regression analysis showed that the maximum valley concentration was higher than that in non-AKI group. The mean valley concentration of vancomycin was a risk factor for the occurrence of vancomycin-related AKI (OR1.13395 CIQ 1.029-1.247P0. 011). The area under the ROC curve for predicting the mean valley concentration of vancomycin was 0.815 (95CI0.709-0.920) P0. 000, the best truncation value was 17.3 mg / L, the sensitivity and specificity were 52.6 mg / L and 83.6respectively. Conclusion Vancomycin may occur acute renal injury during the treatment of severe infection. The mean valley concentration of vancomycin is an independent risk factor for acute renal injury. Patients with mean valley concentration 鈮，

本文編號：2111370