住院患者静脉滴注克林霉素致急性肾损伤危险因素分析

摘要

目的 对住院患者静脉滴注克林霉素致急性肾损伤(AKI)的危险因素进行分析,为临床安全用药提供参考.方法 回顾性分析2016年1月至2018年2月我院106例克林霉素致AKI和同期使用克林霉素但未发生AKI的1 151例患者的临床资料,采用单因素(χ2检验)及多因素(Logistic回归)对肾毒性危险因素进行分析.结果 AKI是克林霉素严重不良反应之一,其发生率为8.43％.单因素分析显示,患者年龄、APACHEⅡ评分、入住ICU、肌酐清除率、血清白蛋白、合并呼吸衰竭、联用利尿剂、联用质子泵抑制剂、联用抗真菌药、克林霉素不同酸根、克林霉素药物浓度和克林霉素用药时间与AKI相关.多因素分析显示,克林霉素药物浓度(＞ 0.6g/100 ml)、APACHEⅡ评分(≥20分)、克林霉素用药时间(≥7 d)、肌酐清除率(≤30 ml/min)、联用质子泵抑制剂、血清白蛋白(＜30 g/L)、合并呼吸衰竭、入住ICU、联用利尿剂和年龄(≥65岁)是克林霉素引起AKI的独立危险因素.大部分AKI患者转归较好,无继发严重肾功能衰竭或尿毒症患者.结论 临床实践中应重点关注有独立危险因素的患者,以保证克林霉素临床安全用药.%Objective To investigate the risk factors for acute kidney injury (AKI) induced by intravenous infusion of clindamycin in inpatients, and to provide reference for clinical safe drug use. Methods The clinical data of106 cases of clindamycin-induced AKI and 1 511 cases who were given clindamycin but did not demonstrate AKI in our hospital fromJanuary 2016 to February 2018 were retrospectively analyzed. The risk factors of nephrotoxicity were analyzed by univariate (χ2test) and multiple factors (Logistic regression). Results AKI was one of the serious ADR of clindamycin, and its incidence rate was 8. 43％. Univariate analysis showed that the patient' s age, APACHEⅡ score, stay in ICU, creatinine clearance rate, serumalbumin, being combined with respiratory failure, combination use of diuretics, combination use of proton pump inhibitors, combination use of antifungal agents, different acid ions of cllincomycin, clindamycin concentration and clindamycin administration time were correlated with AKI. M ultiple factors analysis showed that the concentration of clindamycin (＞ 0. 6 g/100 ml), APACHEⅡ score (≥20), time of clindamycin use (≥7 days), creatinine clearance rate (＜ 30 ml/min), combination use of proton pump inhibitors, serumalbumin (＜30 g/L), being combined with respiratory failure, stay in ICU, combination use of diuretics and patient' s age (≥65years) were independent risk factors for clindamycin-induced AKI. M ost of the AKI patients had better outcomes without secondary severe renal failure or uremia. Conclusion Clinical practice should focus on patients with independent risk factors in order to ensure the clinical safe use of clindamycin.