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目的:探讨万古霉素相关肾毒性发生的危险因素,并进一步分析万古霉素血药浓度对肾毒性及其发生时间的影响。方法:回顾性分析某院155例使用万古霉素治疗的患者,记录患者基本情况及相关用药情况,采用单因素(t检验,χ2检验)及多因素(COX风险比例模型)对肾毒性危险因素进行分析,采用Kaplan-Meier法分析万古霉素血药浓度与肾毒性的发生时间的关系。结果:单因素分析发现,用药前患者的肌酐、尿素、CrCl、入住ICU、联合应用其他具有肾毒性的药物、万古霉素血药浓度值与万古霉素肾毒性相关。多因素分析显示入住ICU、万古霉素血药浓度是肾毒性发生的独立危险因素,而增加万古霉素监测次数则可降低肾毒性发生的可能。进一步研究发现万古霉素血药浓度不同组之间发生肾毒性的时间有显著差异。结论:入住ICU可能提示患者万古霉素肾毒性发生率增高,临床应用万古霉素应及时监测万古霉素血药浓度并增加监测频次减少相关不良反应的发生。
Objective: To investigate the risk factors associated with vancomycin-related nephrotoxicity and further analyze the effect of vancomycin plasma concentration on nephrotoxicity and its timing. Methods: A total of 155 patients treated with vancomycin in a hospital were retrospectively analyzed. The basic conditions and related medication were recorded. One-factor (t-test, χ2 test) and multivariate (COX risk proportional model) Analysis, the use of Kaplan-Meier analysis of vancomycin plasma concentration and nephrotoxicity occurs when the relationship. Results: Univariate analysis showed that vancomycin plasma concentration was associated with vancomycin nephrotoxicity after administration of creatinine, urea, CrCl and ICU in combination with other nephrotoxic drugs. Multivariate analysis showed that ICU vancomycin plasma concentration was an independent risk factor for nephrotoxicity, while increasing the number of vancomycin monitoring could reduce the possibility of nephrotoxicity. Further study found that vancomycin plasma concentration of different groups of time between nephrotoxic have significant differences. CONCLUSIONS: ICU admission may prompt an increase in the incidence of vancomycin nephrotoxicity. Vancomycin should be monitored in clinical practice to monitor vancomycin plasma concentrations and to increase monitoring frequency to reduce the incidence of adverse reactions.