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1、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)、血肌酹和肌酉千清除率，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5
2、3例患者屮有口例发生AKI,发生率为21.0%,AKI组病死率为27.3%o两组患者用药前基础血肌酹和尿素氮无统计学差异，AKI组患者用药前肌肝清除率(67.00±39.59ml/min)低于非AKI组(101.33±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(17.88±4.90mg/L比13.95±4.44mg/L,22.39±7.70mg/L比17.23&pl
3、usmn;6.01mg/L,p=0.017和p二0.027)。Logistic回归分析显示，平均万古霉素谷浓度(OR二1.247,95%CI,1.028-1.514,p=0.025)与低血压(OR二10.759,95%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【屮图分类号】R96【文献标识码】A【文章编号】1672-5085(2014)20-0093-03RiskFactorsforAcuteKidneyInj
4、uryinPatientswithSevereinfectionreceivingVancomycinNIUXiao-rong,GUQin,LIUNing,DepartmentofIntensivecareuint,AffiliatedGulouHospitalofNanjingUniversitySchoolofMedicine,Nanjing,210008,China[AbstractlobjectiveThepurposeofthisstudywastoevaluateriskfactorsthatmayresultpatientswithsevereinfectiontoacutek
5、idneyinjuryinreceivingvancomycintreatment.MethodsThiswasasingle-centerretrospectivestudyof53patienswithsevereinfectionswhowerereceivingvancomycinfromFebruary1st2013toAugust1st2O13.Vancomycintroughconcentrationsandrenalfunctionweremonitoredduringtherapy.Datecollectedineludedthegeneralconditions,vanc
6、omycindose,lengthofvancomycintherapy.Thesewereusedtoidentifyunivariateforvancomycinassociatedacutekindeyinjury.TheunivariateanalysisstatisticallysignificantfactorLogistcregressionanalysis.ResultsAmong53subjects,11(21.0%)develepedacutekidneyinjury,themortalityratewas27.3%.Theinitialserumcreatininean
7、dUremicnitrogendidnotdifferbetweenthetwogroups.ThepatientsinAKIgrouphadlowerinitiallycreatinineclearance(67.00±39.59ml/minvs101.33±51・22ml/min,p=0.046),andthehigherproportionofhypertension[6(5
