肾功能亢进患者应用万古霉素致急性肾损伤的用药监护
投稿时间:2018-12-19  修订日期:2019-03-22  点此下载全文
引用本文:陆灏迪,唐莲,方洁,薛盛敏,尚尔宁,薛苏冬.肾功能亢进患者应用万古霉素致急性肾损伤的用药监护[J].药学实践杂志,2019,37(3):274~278
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作者单位E-mail
陆灏迪 南京医科大学附属苏州医院药学部, 江苏 苏州 215002  
唐莲 南京医科大学附属苏州医院药学部, 江苏 苏州 215002 tanglian716@aliyun.com 
方洁 上海交通大学医学院附属瑞金医院药学部, 上海 200025  
薛盛敏 南京医科大学附属苏州医院药学部, 江苏 苏州 215002  
尚尔宁 南京医科大学附属苏州医院药学部, 江苏 苏州 215002  
薛苏冬 南京医科大学附属苏州医院药学部, 江苏 苏州 215002  
基金项目:江苏省苏州市科技发展计划项目(SYSD2016152);江苏省药学会医院药学基金项目(A201613)
中文摘要:目的 探讨肾功能亢进患者万古霉素个体化用药中出现急性肾损伤的原因。方法 对南京医科大学附属苏州医院使用万古霉素且发生急性肾损伤的3个病例进行药学监护,分析使用群体药动学软件预测万古霉素谷浓度准确性差的原因,寻找发生万古霉素急性肾损伤的原因。结果 在查明患者发生不良反应的原因后,对其进行针对性治疗,均获得较好的控制与转归。结论 肾功能亢进患者出现万古霉素相关性肾损害主要为联用肾毒性药物、肾脏灌注不足,临床用药中需加强用药监护,提高万古霉素用药安全性。
中文关键词:肾功能亢进  万古霉素  急性肾损伤  不良反应
 
Drug monitoring of acute kidney injury induced by vancomycin in patients with augmented renal clearance
Abstract:Objective To investigate the causes of acute kidney injury in patients with augmented renal clearance during individualized application of vancomycin.Methods Three cases of acute kidney injury caused by vancomycin in our hospital were taken pharmaceutical care.The reasons for the inaccuracy of using population pharmacokinetic software to predict the trough concentration of vancomycin were analyzed,and the causes of acute kidney injury caused by vancomycin were found.Results After ascertaining the causes of the adverse reactions of the patients,targeted treatment was carried out,and all of them were well controlled and turned over.Conclusion The main causes of vancomycin-associated renal damage in patients with augmented renal clearance were combined the use of nephrotoxic drugs and renal perfusion insufficiency.It is necessary to strengthen drug monitoring in clinical medication to improve the safety of vancomycin.
keywords:augmented renal clearance  vancomycin  acute kidney injury  adverse reaction
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