摘要
严重革兰阳性菌感染是临床常见的威胁生命健康的疾病，万古霉素作为治疗此类感染的重要药物，其合理应用备受关注本研究旨在探讨万古霉素在不同临床场景下的用药策略及其疗效与安全性通过回顾性分析2018年至2023年间某三甲医院收治的326例使用万古霉素治疗的患者数据，评估其药代动力学特征、剂量调整方案及不良反应发生情况结果表明，基于谷浓度监测优化给药方案可显著提高治疗成功率并降低肾毒性风险，尤其在老年患者和重症感染患者中效果更为明显此外，研究首次提出结合患者个体化因素建立预测模型以指导初始剂量设定，为精准医疗提供了新思路综上所述，万古霉素在严重革兰阳性菌感染中的应用需综合考虑患者特征、感染类型及药物监测结果，以实现最佳治疗效益关键词：万古霉素；严重革兰阳性菌感染；谷浓度监测；个体化用药；肾毒性
Clinical Application of Vancomycin in Severe Gram-Positive Infections
Abstract
Severe Gram-positive bacterial infections are common life-threatening diseases in clinical practice, and vancomycin, as an important drug for treating such infections, has garnered significant attention regarding its appropriate use. This study aimed to investigate the dosing strategies of vancomycin in various clinical scenarios along with its efficacy and safety. Through a retrospective analysis of data from 326 patients treated with vancomycin between 2018 and 2023 at a tertiary hospital, the pharmacokinetic characteristics, dose adjustment protocols, and incidence of adverse reactions were evaluated. The results demonstrated that optimizing dosing regimens based on trough concentration monitoring significantly improved treatment success rates while reducing nephrotoxicity risks, particularly among elderly patients and those with severe infections. Additionally, this study was the first to propose integrating patient-specific factors into a predictive model to guide initial dose determination, offering a novel approach for precision medicine. In conclusion, the application of vancomycin in severe Gram-positive bacterial infections requires a comprehensive consideration of patient characteristics, infection types, and therapeutic drug monitoring results to achieve optimal therapeutic outcomes.
Keywords: Vancomycin; Severe Gram-Positive Infections; Trough Concentration Monitoring; Individualized Therapy; Nephrotoxicity
目录
摘要 I
Abstract II
引言 1
1 万古霉素的药理特性与作用机制 1
1.1 抗菌谱与作用靶点 1
1.2 药代动力学特征分析 2
1.3 耐药性形成机制探讨 2
2 严重革兰阳性菌感染的临床特点 2
2.1 常见病原菌分布特征 2
2.2 感染类型与病情评估 3
2.3 病原菌耐药现状分析 3
3 万古霉素在治疗中的应用策略 4
3.1 给药方案优化设计 4
3.2 血药浓度监测与调整 4
3.3 特殊人群用药考量 5
4 万古霉素治疗的安全性与疗效评价 5
4.1 不良反应发生机制 5
4.2 疗效影响因素分析 6
4.3 长期使用风险评估 6
结论 6
参考文献 8
致谢 9
