| Objective:A high performance liquid chromatographic method was established to detect the serum and cerebrospinal fluid concentrations of vancomycin.According to the results of neurosurgical patients,the relationship between vancomycin concentration and curative effect in patients with neurosurgery was analyzed.Promote the development of clinical pharmacists in clinical drug therapy.Methods:Using high performance liquid chromatography to establish a method of monitoring vancomycin concentration in serum and cerebrospinal fluid.We measured the drug concentration in patients who received vancomycin in our department of neurosurgery between January 2017 and December 2017.Application of Excel,SPSS.22 software for statistical analysis of test results from the aspects of clinical application effectiveness,safety,and factors that affect drug concentration.Results:Establish a linear regression equation for vancomycin in serum drug concentrations ranging from 5 to 100 mg·L-1:y=3771.5x+49454,r=0.9994.The lower limit of quantitation and detection limit were 5 mg·L-1.Vancomycin regression equation in cerebrospinal fluid was y=13637x+16570,r=0.9990.The lower limit of quantitation and detection limit were 0.5 mg.L-1.Good specificity;intraday RSD<8%for vancomycin in serum samples,RSD<6%for daytime;intraday RSD values for standard samples of cerebrospinal fluid<10%,RSD values for daytime<8%;recovery rates of 96-110%Within the range,RSD<5%;serum samples and cerebrospinal fluid samples were placed in the room for 24 hours,-80°C refrigerator freezer for 28 days,repeated freezing and thawing 3 times,the RSD value of the detection value was less than 7%.Methodological examination meets the requirements.A total of 136 samples were collected from 44 patients;the average dose was?38.78±9.08?mg·kg-1·d-1;and the vanillin plasma concentration was?18.58±15.19?mg·L-1;The median vancomycin concentration in cerebrospinal fluid was 1.53 mg·L-1,and the transmissivity was?14.03±12.99?%.60.29%of patients were effective in anti-infection,and the bacterial clearance rate in cerebrospinal fluid could reach83.33%;the vancomycin concentration in cerebrospinal fluid could be more effective in the range of 4-8mg·L-1?P=0.044?,vancomycin concentration in serum At a dose below 10 mg·L-1,there was a negative effect on efficacy?P=0.022?.ADR was associated with vancomycin serum trough concentrations,aminoglycosides,and diuretics?P<0.05?.There was a significant difference in the concentration of vancomycin in cerebrospinal fluid between patients with different diseases?P=0.038?;there was a strong linear relationship between the concentration of cerebrospinal fluid in vancomycin and albumin in blood,and lactate dehydrogenase in cerebrospinal fluid?P<0.01?.The relationship between serum vancomycin concentration and serum albumin content was statistically significant?P=0.029?;transmission rate was linearly related to albumin content in blood and protein content in cerebrospinal fluid?P<0.05?;The variables included in the linear regression equation and the models constructed by the dependent variables were statistically significant?P<0.05?;the aminoglycosides and vancomycin had strong negative correlations in the concentration and transmissibility of cerebrospinal fluid?P<0.001?.Conclusion:It is difficult for patients with neurosurgery to use conventional doses of vancomycin to meet the effective concentration range.The dosage should be calculated according to the guidelines and TDM should be performed..The serum and cerebrospinal fluid concentrations of vancomycin can provide reference for clinical treatment and can reflect the effectiveness,safety;There are many factors affecting the patient's vancomycin drug concentration;drug concentration monitoring is a necessary supplementary treatment for special patients,clinical pharmacists involved in clinical drug treatment,is an integral part of the team medical. |
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