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目的 研究老年患者使用万古霉素的肾毒性及影响肾毒性发生的各种因素。方法 选择 2 2例因肺部感染或肾盂肾炎并且其致病菌对万古霉素敏感 ,而静脉使用万古霉素的老年患者 ,观察用药前后肾功能指标的变化。万古霉素的用量根据血清肌酐清除率相应调整 ,按照 APACHE评分法研究影响万古霉素肾毒性的各种因素。结果 万古霉素的血药浓度不是影响其肾毒性的唯一指标 ,而 APACHE评分有助于预测万古霉素的肾毒性。高龄老年人是万古霉素肾毒性的高危人群。结论 万古霉素对于多数老年患者是安全的。但是对于 APACHE评分大于 40的危重高龄老年患者 ,其肾毒性严重 ,甚至导致肾功能衰竭
Objective To study the nephrotoxicity of vancomycin in elderly patients and the various factors that affect nephrotoxicity. Methods 22 elderly patients with pulmonary infection or pyelonephritis and their pathogens sensitive to vancomycin were selected. The changes of renal function indexes before and after treatment were observed in elderly patients with intravenous vancomycin. The amount of vancomycin was adjusted according to the serum creatinine clearance rate, according to APACHE score method to study the various factors that affect vancomycin nephrotoxicity. Results The plasma concentration of vancomycin was not the only indicator of nephrotoxicity, and the APACHE score helped predict nephrotoxicity of vancomycin. Older seniors are at high risk of vancomycin nephrotoxicity. Conclusion Vancomycin is safe for most elderly patients. However, critically ill elderly patients with an APACHE score greater than 40 have severe nephrotoxicity and may even cause renal failure