| Objective:Serum vancomycin concentration of critical patients was affected by various factors.Both renal function and serum album could affect pharmacokinetics of vancomycin.This study was designed to analyse the metabolic characteristics of vancomycin at different levels of renal function and explore the factors that affected pharmacokinetics of vancomycin and its optimal dosage in critical patients.Methods:Critical patients who used vancomycin during January 2016 to December 2016 in intensive care unit?ICU?of the Second Hospital of Ji Lin University were enrolled in this trial.Datas such as the patient's gender,age,height,weight,APACHE ?score,cystatin C,serum creatinine,serum album,urine output,dosage of vancomycin and serum trough concentration were collected and analyzed.They were divided into normal renal function group?CCr?60ml/min·1.73m2?and decreased renal function group?CCr<60ml/min·1.73m2?according to the level of creatinine clearance.Then,according to trough concentration of vancomycin,they were divided into three groups: trough concentration < 10mg/L group,trough concentration1020mg/L group and trough concentration >20mg/L group.These factors such as the patient's gender,age,height,weight,APACHE?score,cystatin C,serum creatinine,serum album,urine output,dosage of vancomycin and serum trough concentration were analyzed at different levels of renal function and trough concentration.Results:In normal renal function group,it was found that only 27.27%?6?reached the target concentration?1020mg/L?,40.91%?9?<10mg/L and 31.82%?7?>20mg/L.In decreased renal function group,it was found that 37.50%?9?reached the target concentration?1020mg/L?,50.00%?12?<10mg/L and 12.50%?3?>20mg/L.In decreased renal function group,age,cystatin C and APACHE?score were all higher than those in normal renal function group(t age =-1.31,P age =0.198;t cystatin C=-5.68,P cystatin C =0.000;t APACHE?=-2.79,P APACHE?=0.008);serum album,urine output and dosage of vancomycin were lower than those in normal renal function group(t serum album =2.63,P serum album =0.011;t urine output =2.63,P urine output=0.012;t dosage =5.07,P dosage =0.000);the average vancomycin trough concentration were higher than that in normal renal function group,but there was no statistically significant difference?t trough concentration =-1.13,P trough concentration =0.263?.When renal function was decreased,in trough concentration<10mg/L group,serum album was higher and cystatin C was lower than that in trough concentration?1020mg/L?group(t serum album =4.37,P serum album =0.001;t cystatin C=-2.83,P cystatin C =0.014);creatinine clearance rate had no obvious difference in two groups?t CCr=0.58,PCCr=0.574?;trough concentration>20mg/L group compared with trough concentration?1020mg/L?group,serum album and cystatin C had obvious difference(t serum album =3.56,P serum album =0.004;t cystatin C =-2.35,P cystatin C=0.039),but creatinine clearance rate had no difference?t CCr=1.08,PCCr=0.303?.When renal function was normal,trough concentration < 10mg/L group compared with trough concentration?1020mg/L?group,urine output had obvious difference?t? ?=2.29,P? ?=0.034?,but age,serum album,cystatin C and APACHE? score had no difference(t age =-1.09,P age =0.290;t serum album =0.24,P serum album=0.813;t cystatin C =-1.33,P cystatin C =0.198;t CCr=1.15,PCCr=0.262;t APACHE?=-0.46,P APACHE?=0.650);trough concentration>20mg/L group compared with trough concentration?1020mg/L?group,age,serum album,urine output,cystatin C,CCr and APACHE? score had no difference(t age =-0.56,P age =0.586;t serum album =0.11,P serum album =0.916;t urine output =-0.21,P urine output =0.835;t cystatin C=-0.98,P cystatin C =0.350;t CCr=-0.37,PCCr=0.717;t APACHE?=-0.02,P APACHE?=0.982).Urine output,CCr and dosage of vancomycin were found to be correlated to serum trough concentrations by multiple linear regression analysis(t Urine output =-2.90,P Urine output =0.006;t CCr=-0.092,PCCr=0.005;t dosage =3.859,Pdosage=0.000),while age,serum album,cystatin C and APACHE?score had no correlation with serum trough concentrations.Conclusion:When renal function was decreased,serum album could increase the serum trough concentration of vancomycin.When renal function was normal,Urine output was negatively correlated with vancomycin concentration.CCr,urine output and dosage of vancomycin were found to be correlated to serum trough concentrations.Making a dosage plan were not only based on creatinine clearance.The factors mentioned above should be taken into consideration in dosage to be given. |
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