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医院获得性肺炎患者美罗培南血药浓度不达标的危险因素分析 Δ
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石 璐 ，陈 芳 ，鲁广先 ，段露芬 ，陆 件 ，庄智伟 ，徐金慧 ，许洪涛 ，吴 超 ，周 琴 ，唐 莲 （1.南
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京医科大学附属苏州医院药剂科，江苏 苏州 215002；2.南京医科大学附属苏州医院重症医学科，江苏 苏州
215002；3.南京医科大学附属苏州医院急诊监护室，江苏 苏州 215002；4.杭州佰辰医学检验所有限公司，
杭州 310012）
中图分类号 R974；R969.1 文献标志码 A 文章编号 1001-0408（2022）19-2388-05
DOI 10.6039/j.issn.1001-0408.2022.19.17
摘 要 目的 分析医院获得性肺炎（HAP）患者美罗培南血药浓度不达标的危险因素。方法 选择南京医科大学附属苏州医院
2020年1月至2021年6月入住重症监护室且行美罗培南稳态血药谷浓度检测的130例HAP患者为研究对象。记录患者的年龄、
性别、体质量等病史资料。测定美罗培南稳态血药谷浓度，并确定其靶标。采用单因素和多因素Logistic回归分析法筛选美罗培
南稳态血药谷浓度不达标的危险因素，绘制受试者工作特征（ROC）曲线筛选危险因素的警戒值并评估危险因素的预测价值。
结果 美罗培南稳态血药谷浓度≥2 mg/L的有85例，稳态血药谷浓度＜2 mg/L的有45例。多因素Logistic回归分析显示，年龄、负
平衡量、颅脑损伤为美罗培南稳态血药谷浓度不达标的独立危险因素（P＜0.05）。ROC曲线显示，患者年龄为58岁时，ROC曲线
下面积最大（0.744），灵敏度为0.882，特异度为0.556，约登指数为0.438；负平衡量为520.5 mL/24 h时，ROC曲线下面积达到最大
（0.827），灵敏度为0.722，特异度为0.905，约登指数为0.628。颅脑损伤组患者的肌酐清除率显著高于非颅脑损伤组患者、美罗培
南稳态血药谷浓度显著低于非颅脑损伤组患者（P＜0.001）。结论 HAP 患者年龄＜58 岁、存在颅脑损伤及负平衡量＞520.5
mL/24 h时，美罗培南稳态血药谷浓度不达标的风险会增加。
关键词 美罗培南；医院获得性肺炎；血药谷浓度；治疗药物监测；肌酐清除率；危险因素
Risk factors of substandard drug blood concentration of meropenem in patients with hospital-acquired
pneumonia
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SHI Lu ，CHEN Fang ，LU Guangxian ，DUAN Lufen ，LU Jian ，ZHUANG Zhiwei ，XU Jinhui ，XU Hongtao ，
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WU Chao ，ZHOU Qin ，TANG Lian（1. Dept. of Pharmacy，Suzhou Hospital Affiliated to Nanjing Medical
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University，Jiangsu Suzhou 215002，China；2. Dept. of Critical Care Medicine，Suzhou Hospital Affiliated to
Nanjing Medical University， Jiangsu Suzhou 215002， China；3. Emergency Care Unit， Suzhou Hospital
Affiliated to Nanjing Medical University， Jiangsu Suzhou 215002， China；4. Hangzhou Baichen Medical
Laboratory Co.，Ltd.，Hangzhou 310012，China）
ABSTRACT OBJECTIVE To analyze the risk factors of substandard drug blood concentration of meropenem in patients with
hospital acquired pneumonia（HAP）. METHODS Totally 130 HAP patients who were admitted to the intensive care unit of Suzhou
Hospital Affiliated to Nanjing Medical University from January 2020 to June 2021 and received steady-state blood concentration test
of meropenem were selected as the study subjects. The patient’s age，sex，body mass and other medical history were recorded. The
steady-state blood trough concentration of meropenem was determined and its target was determined. Univariate and multivariate
Logistic regression analysis were used to screen the risk factors for the substandard steady-state blood trough concentration of
meropenem. The receiver operating characteristic （ROC） curve was drawn to screen the warning value of the risk factors and
evaluate the predictive value of the risk factors. RESULTS The steady-state blood trough concentrations of 85 cases were ≥2 mg/L，
and those of 45 cases were ＜2 mg/L. Multivariate Logistic
Δ 基金项目 江苏省药学会医院药学科研项目（No.H202109，No. regression analysis showed that age， negative balance and
A201915）；苏州市科技发展计划（No.SYSD2019189）；苏州市临床重点
brain injury were independent risk factors for the substandard
病种诊疗技术专项（No.LCZX202112）
steady-state blood trough concentration of meropenem （P＜
＊第一作者 副主任药师。研究方向：抗感染药学。电话：025-
0.05）.ROC curve showed that when the patient was 58 years
62362724。E-mail：718488203@qq.com
old，the area under the ROC curve was the largest（0.744），
#a 通信作者 主任药师。研究方向：抗感染药学。电话：025-
62362325。Email：chenfang858@126.com the sensitivity was 0.882，the specificity was 0.556，and the
#b通信作者 副主任药师。研究方向：抗感染及ICU药学。电话： Youden index was 0.438；when the negative balance was 520.5
025-62362325。E-mail：tanglian716@aliyun.com mL/24 h，the area under the ROC curve reached the maximum
·2388· China Pharmacy 2022 Vol. 33 No. 19 中国药房 2022年第33卷第19期
