目的:评价本院万古霉素血药浓度监测(therapeutic drug monitoring, TDM)结果和临床应用情况。方法:回顾性收集2023年在我院使用万古霉素并检测血药浓度患者的临床资料,并结合检测结果和临床应用评价万古霉素的用药合理性。结果:136例患者共报告万古霉素TDM 184例次,患者平均给药(5.29 ± 3.5) d后首次进行TDM检测,37.30%患者监测结果在10~20 μg/mL范围内。28例次检测结果超过危急值(30 μg/mL),其中5位患者发生肾功能损害。结论:本院万古霉素应用过程中存在标本送检偏晚、联合用药不合理以及万古霉素浓度达标率低等问题。使用万古霉素需加强血药浓度监测,并结合患者的临床情况选择适当的给药方案进行个性化治疗。Objective: To evaluate the therapeutic drug monitoring (TDM) of vancomycin and its clinical application in our hospital. Methods: Clinical data of patients used vancomycin in our hospital in 2023 were retrospectively collected, and the rationality of vancomycin was evaluated by combining the test results and clinical application. Results: A total of 136 patients were included, vancomycin TDM was reported in 184 cases. An average of (5.29 ± 3.5) days of administration followed by the first vancomycin TDM test. 37.30% of patients had monitoring results within the range of 10~20 μg/mL. 28 test results exceeded the critical value (30 μg/mL), with 5 patients occurred acute kidney injury. Conclusion: The challenges of vancomycin used in our hospital include, delays in TDM specimen collection, unreasonable combination therapy and low compliance rate of vancomycin concentration. The use of vancomycin requires enhanced monitoring of blood concentrations and the selection of appropriate dosing regimens for individualized treatment in conjunction with the patient’s clinical situation.
利奈唑胺是一种新型的唑烷酮类抗生素,是治疗耐药结核病的关键药物,该药治疗窗口狭窄,虽然疗效明显,但是临床应用不良反应的发生率高,如何安全有效地应用该药治疗耐药结核病一直困扰临床医生。治疗药物监测(therapeutic drug monitoring,TDM)通过监测患者血液中的药物浓度,可为药物剂量调整提供依据,使药物达到有效治疗浓度的同时最大程度地降低不良反应发生。目前国内外均有报道利用TDM研究利奈唑胺在耐药结核病患者中的最佳使用剂量和疗程,探讨利奈唑胺的谷浓度、峰浓度与不良反应发生率之间的关系,特别是对老年人、儿童、肝肾功能不全的患者临床安全使用利奈唑胺个体化治疗进行系列的探索研究。本文对利奈唑胺不良反应的发生机制、利奈唑胺的使用剂量及安全性、利奈唑胺药物浓度的影响因素、TDM的方式和应用等进行综述,为更加安全有效地应用利奈唑胺治疗耐药结核病提供参考。
