摘要
目的探讨西司他丁对万古霉素肾脏毒性的保护作用。方法收集2016年6月至2021年6月急诊重症监护病房(ICU)收治的使用万古霉素(单用组)或联合使用西司他丁(联用组)的重症感染患者的临床资料。记录并比较2组患者的性别分布、年龄、体质量、基础疾病、临床诊断、病情严重程度评分、用药前后肾功能、万古霉素和西司他丁平均日剂量及疗程,以及ICU住院时间等资料。结果共纳入患者210例(单用组127例,联用组83例)。在入院诊断中,单用组以肺部感染居多(占63.0%),而联用组则以急性重症胰腺炎居多(占49.4%)。与单用组相比,联用组的快速序贯器官功能衰竭评分(q SOFA)较高[1.0(0,1.0)vs 0(0,0.25),P<0.01],基础肾功能更差[血清肌酐(μmol·L^(-1)):94.0(64,178.5)vs 56.0(42.0,71.0),P<0.05;血尿素氮(mmol·L^(-1)):11.7(6.7,18.6)vs 4.7(3.5,8.1),P<0.05],万古霉素日剂量较低[(22.00±9.76)mg·kg^(-1)·d^(-1)vs(25.51±9.56)mg·kg^(-1)·d^(-1),P<0.05]。联用组患者用药后的肾功能指标较用药前改善,而单用组则恶化。联用组ICU住院时间也较单用组明显缩短。结论西司他丁可以显著降低万古霉素的肾毒性,明显缩短患者的住院时间,提高临床疗效,降低不良反应。
AIM To explore the protective effect of cilastatin on nephrotoxicity of vancomycin.METHODS Clinical data of critically infected patients treated with vancomycin or cilastatin combined in the emergency intensive care unit(ICU)from June 2016 to June 2021 were collected and divided into 2 groups:vancomycin alone and vancomycin combined cilastatin.The gender distribution,age,body mass,underlying diseases,clinical diagnosis,severity score,renal function before and after medication,average daily dose and course of vancomycin and cilastatin,and length of ICU stay were recorded and compared between 2 groups.RESULTS A total of 210 patients wered enrolled,with 127 patients in the vancomycin alone group,and 83 patients in the vancomycin combined cilastatin group.In admission diagnosis,lung infection(63.0%)was more common in the vancomycin alone group,while acute severe pancreatitis(49.4%)was more common in the vancomycin combined cilastatin group.Compared with the vancomycin alone group,the quick sequential organ failure assessment(qSOFA)score in the vancomycin combined cilastatin group significantly was higher than in the vancomycin alone group[1.0(0,1.0)vs 0(0,0.25),P<0.01],but the basic renal function was poorer[serum creatinine(SCr,μmol·L^(-1)):94.0(64,178.5)vs 56.0(42.0,71.0),P<0.05;blood urea nitrogen(BUN,mmol·L^(-1)):11.7(6.7,18.6)vs 4.70(3.5,8.1),P<0.05],and the daily dose of vancomycin was also significantly lower[(22.00±9.76)mg·kg^(-1)·d^(-1)vs(25.51±9.56)mg·kg^(-1)·d^(-1),P<0.05].The renal function indexes of patients were getting worse significantly after treatment in the vancomycin alone group,while those in vancomycin combined cilastatin group were improved.The length of ICU stay was significantly shorter than that in the vancomycin alone group.CONCLUSION Cilastatin can significantly reduce the nephrotoxicity of vancomycin,shorten the length of hospital stay,improve clinical efficacy and reduce adverse reactions.
作者
李娟
毛恩强
陈尔真
何娟
LI Juan;MAO Enqiang;CHEN Erzhen;HE Juan(Department of Pharmacy,Suining Central Hospital,Sichuan Province,Suining 629000,China;Department of Emergency Intensive Care Unit,Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China;Department of Pharmacy,Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)
出处
《中国临床药学杂志》
CAS
2022年第9期689-693,共5页
Chinese Journal of Clinical Pharmacy
基金
上海市卫生计生系统重要薄弱学科建设基金(编号2016ZB0206)
上海瑞金医院院级多中心临床研究课题基金(编号2018CR004)
关键词
重症患者
万古霉素
西司他丁
肾毒性
critically ill patient
vancomycin
cilastatin
nephrotoxicity
