重症感染患者万古霉素相关急性肾损伤的临床特点及危险因素分析.docVIP

精品论文 参考文献 重症感染患者万古霉素相关急性肾损伤的临床特点及危险因素分析 牛晓蓉 (南京大学医学院 210000） 　　【摘要】目的 探讨重症感染患者发生万古霉素相关急性肾损伤（AKI）的临床特点以及相关因素分析。方法 选择南京大学医学院附属鼓楼医院重症医学科2013年2月至2013年8月使用万古霉素经验性或目标性抗感染治疗的患者53例，监测万古霉素血药浓度（谷浓度）、血肌酐和肌酐清除率，并记录患者基础状态、万古霉素的用药剂量及疗程。依据用药期间是否发生AKI分为AKI组和非AKI组，将肾功能、万古霉素血药浓度、万古霉素用药剂量和疗程分别进行单因素分析和Logistic回归分析，筛选万古霉素相关肾损伤的危险因素。结果 53例患者中有11例发生AKI，发生率为21.0%，AKI组病死率为27.3%。两组患者用药前基础血肌酐和尿素氮无统计学差异， AKI组患者用药前肌酐清除率（67.00plusmn;39.59ml/min）低于非AKI组（101.33plusmn;51.22ml/min），p=0.046，低血压的例数（6例）多于非AKI组（5例），p=0.003；两组患者首次万古霉素谷浓度无统计学差异，AKI组患者平均万古霉素谷浓度、最大谷浓度较非AKI组患者高（17.88plusmn;4.90mg/L比13.95plusmn;4.44mg/L，22.39plusmn;7.70mg/L比17.23plusmn;6.01mg/L，p=0.017和p=0.027）。Logistic回归分析显示，平均万古霉素谷浓度（OR=1.247，95%CI，1.028-1.514，p=0.025）与低血压（OR=10.759，95%CI，1.667-69.442,p=0.013）是引起万古霉素相关AKI发生的危险因素。结论 万古霉素谷浓度和低血压是影响万古霉素相关急性肾损伤的独立危险因素，用药期间需定期检测血药浓度。 　　【关键词】重症 感染 万古霉素 肾损伤 危险因素 　　【中图分类号】R96 【文献标识码】A 【文章编号】1672-5085（2014）20-0093-03 　　Risk Factors for Acute Kidney Injury in Patients with Severe infection receiving Vancomycin 　　NIU Xiao-rong，GU Qin，LIU Ning，Department of Intensive care uint，Affiliated Gulou Hospital of Nanjing University School of Medicine，Nanjing，210008，China 　　【Abstract】objective The purpose of this study was to evaluate risk factors that may result patients with severe infection to acute kidney injury in receiving vancomycin treatment. Methods This was a single-center retrospective study of 53 patiens with severe infections who were receiving vancomycin from February 1st 2013 to August 1st 2013.Vancomycin trough concentrations and renal function were monitored during therapy.Date collected included the general conditions，vancomycin dose，length of vancomycin therapy.These were used to identify univariate for vancomycin associated acute kindey injury. The univariate analysis statistically significant factor Logistc regression analysis. Results Among 53 subjects，11(21.0%)develeped acute kidney injury，the mortality rate was 27.3%.