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題名 | 分析肥胖病人用Vancomycin藥動學=Vancomycin Pharmacokinetics in Obese Patients |
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作者 | 葉春蘭; 蘇慧真; 王慧瑜; | 書刊名 | 藥學雜誌 |
卷期 | 30:2=119 2014.06[民103.06] |
頁次 | 頁64-68 |
分類號 | 418.281 |
關鍵詞 | 藥物血中濃度監測; 藥物動力學; Vancomycin; |
語文 | 中文(Chinese) |
中文摘要 | 大部分文獻顯示肥胖病人使用 vancomycin 較適合使用實際體重建議劑量,然而 目前也有文獻建議較低的每日劑量仍可達到有效治療濃度並降低腎毒性,因此本文 運用藥物血中濃度監測 (Therapeutic Drug Monitoring,TDM) 結果, 回溯性蒐集某醫 學中心99年1月至102年4月使用 vancomycin,腎功能正常,年齡介於18歲至65歲非老 年人,依據 BMI 指數區分為正常體重 (18.5 ≦ BMI < 24 kg/m2) 和肥胖 (BMI ≧ 27 kg/ m2) 兩大族群,並依據當時監測結果算出藥物動力學參數,比較兩者之間分佈體積和 清除率之差異,以利進一步分析肥胖病人適當的建議劑量。 初步結果肥胖病人共蒐集49位,正常體重病人53位,肥胖病人平均每日使用劑量 以理想體重表示為32.6 ± 8.35 mg/kg/day IBW,正常體重病人為30.37 ± 8.44 mg/kg/ day IBW;給藥間隔肥胖病人為9.92 ± 2.61 hr,正常體重病人為10.38 ± 2.45 hr,兩 者並無統計上差異,然而 TDM 監測結果肥胖病人平均 vancomycin 波峰濃度為21.4 ± 7.11 μg/mL,正常體重病人為25.43 ± 8.9 μg/mL;波谷濃度肥胖病人為8.44 ± 3.98 μg/ mL,正常體重病人為10.9 ± 5.81 μg/mL,兩者均較正常體重病人為低,並具有統計 上差異 (p < 0.05),進一步分析藥物動力學參數,發現肥胖病人平均分佈體積為48.42 ± 14.26 L,高於正常體重病人42.46 ± 11.73 L;清除率肥胖病人平均為5.99 ± 2.0 L/ h,高於正常體重病人4.67 ± 1.79 L/h,兩者均具有統計上差異 (P < 0.05),且發現肥 胖病人 vancomycin 清除率和調整體重的相關性優於和實際體重的相關性 (r = 0.4431 vs 0.3524,P < 0.05),此結果暗示著非老年肥胖病人較適合使用調整體重建議劑量。 |
英文摘要 | The aim of this study was to determine an appropriate dose of vancomycin for nonelderly obese patients in Taiwan. This is a retrospective study conducted at a medical center which has pharmacist-guided therapeutic drug monitoring programs. Patients with normal renal function and age 18 to 65 years who received vancomycin between Jan 1, 2010 to April 30, 2013 were recruited and divided into two groups, obese subjects (BMI ≧ 27 kg/m2) and normal weight control (18.5 ≦ BMI < 24 kg/m2). Pharmacokinetic parameters alteration were computed to compare the difference of volume of distribution (Vd)、clearance (CL) between obese and normal weight patients, and to determine the appropriate vancomycin dose. There were no significant differences between two groups in the interval and dosage of vancomycin (means of dosage were respectively 32.6 ± 8.35 mg/kg/day IBW in the obese patients and 30.37 ± 8.44 mg/kg/day IBW in the normal weight patients), but the peak and trough concentration were significantly lower in the obese patients than those in the normal weight patients. Further analysis of pharmacokinetic parameters, the mean Vd and CL in the obese patients were much significantl than those in the normal weight patients. The clearance of vancomycin in obese patients have a better correlation with adjusted body weight (ABW) than total body weight (TBW) (r = 0.4431 vs 0.3524,P < 0.05). These results implied that ABW should be used to calculate vancomycin doses for non-elderly obese patients. |
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