Effect of augmented renal clearance after cranial surgery on the pharmacokinetics and pharmacodynamics of vancomycin
Objective To investigate the effect of augmented renal clearance(ARC)after cranial surgery on the pharmacokinetics and pharmacodynamics of vancomycin.Methods A total of 45 patients(ARC group)were selected after receiving anti-infection vancomycin after craniocerebral surgery in the Eighth People's Hospital of Qingdao from February 2021 to February 2023.A total of 135 patients without ARC(control group)were selected according to 1∶3 in the same period.Blood concentration and pharmacokinetic parameters of vancomycin were monitored,and clinical indicators of the two groups were measured before and after treatment,and the duration of vancomycin administration and hospital stay were counted.Results One case died in the ARC group,5 cases in the control group changed treatment regimens,3 cases were transferred to the hospital,and 2 cases died in the middle of the group,and 44 cases in the ARC group and 125 cases in the control group were finally included.The time of stable state of plasma concentration,average trough concentration and the rate of meeting the standard of trough concentration in ARC group were lower than those in control group[(3.61±1.26)d vs(4.95±1.53)d,(8.49±2.14)mg/L vs(13.46±4.09)mg/L,18.18%vs 48.00%].The average daily dose of vancomycin was higher than that of control group[(2171.26±359.33)mg vs(1846.17±316.26)mg],and the differences were statistically significant(P<0.05).The vancomycin clearance rate and apparent volume distribution of vancomycin in ARC group were higher than those in control group[(6.91±1.19)L/h vs(4.26±1.01)L/h,(69.02±16.26)L vs(61.21±13.59)L].Terminal half-life and area under drug-time curve were lower than those of control group[(3.55±1.25)h vs(4.28±1.94)h,(301.26±95.77)h·mg/L vs(365.79±112.54)h·mg/L],and the differences were statistically significant(P<0.05).Body temperature,neutrophil percentage,white blood cell count,procalcitonin and C-reactive protein levels after treatment were lower than those before treatment,and the ratio of cerebrospinal fluid glucose to serum glucose was higher than those before treatment,with statistical significance(P<0.05).There was no significant difference in clinical indexes between the two groups after treatment(P>0.05).Compared with the control group,the course of vancomycin,ICU stay and total hospital stay in the ARC group were longer than those in the control group[(6.91±1.18)d vs(4.26±1.0)d,(5.95±1.18)d vs(4.16±1.43)d,(22.70±5.16)d vs(20.76±4.72)d],and the differences were statistically significant(P<0.05).Conclusion ARC after craniocerebral surgery can reduce the plasma concentration of vancomycin,affect the pharmacokinetics and efficacy,and prolong the course of medication and hospital stay.
craniocereologyaugmented renal clearancevancomycinblood drug concentrationpharmacokineticscurative effect
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