目的:评估心脏病患者的心脏功能及肾功能对万古霉素清除率的影响。方法:对303例患者在使用了万古霉素注射1 h后以及下一次用药前的血清浓度进行检测,同时检测患者左心室射血分数(LVEF)。根据2次检测结果计算万古霉素的药动学参数。结果:LVEF<50%(69例)的患者以及50%≤LVEF<75%的患者(108例),其万古霉素的清除率显著低于LVEF≥75%(126例)的患者[万古霉素清除率分别为(2.39±0.94)和(2.78±0.98)L·h-1 vs(3.51±1.05)L·h-1 P<0.001或P<0.01]。万古霉素的清除率不仅与LVEF<50%(r=0.827)和50%≤LVEF<75%(r=0.774)患者的肌酐清除率的估计值高度相关,同时与肌酐清除率(Ccr)<60 ml·min-1患者的左心室射血分数有关(r=0.645)。Logisitic回归分析提示Ccr、LVEF和体质量是万古霉素清除率的重要的独立变量(r2=0.650)。结论:万古霉素清除率随着LVEF和Ccr的降低而降低。提示万古霉素清除率除受到患者肾功能影响外还受到患者心脏功能的影响,因此在临床使用中需要参考患者的Ccr和LVEF数值来调整万古霉素的用量。 PURPOSE: To assess the effects of heart function and renal function on vancomycin clearance in patients with heart disease. Methods: Serum concentrations of 303 patients were measured at 1 h after vancomycin injection and before the next dose, and left ventricular ejection fraction (LVEF) was measured. The pharmacokinetic parameters of vancomycin were calculated according to the results of two tests. Results: The patients with LVEF <50% (69 cases) and 50% ≤ LVEF <75% (108 cases) had significantly lower vancomycin clearance than those with LVEF ≥75% (126 cases) [Vancomycin The clearance rate was (2.39 ± 0.94) and (2.78 ± 0.98) L · h-1 vs (3.51 ± 1.05) L · h-1, P <0.001 or P <0.01]. Vancomycin clearance was highly correlated not only with estimates of creatinine clearance in patients with LVEF <50% (r = 0.827) and 50%