目的 通過分析重癥患者伏立康唑血藥谷濃度的變化，探討重癥患者最優(yōu)化的伏立康唑給藥方案。方法 采用回顧性分析研究，選擇2014年12月-2016年12月入住南京大學(xué)醫(yī)學(xué)院附屬鼓樓醫(yī)院重癥醫(yī)學(xué)科使用伏立康唑并監(jiān)測伏立康唑血藥谷濃度的重癥患者，從性別、年齡、體重、APACHE2評分、劑量、總膽紅素、白蛋白與濃度相關(guān)性，濃度分布情況、質(zhì)子泵抑制劑對伏立康唑血藥谷濃度的影響及療效等進(jìn)行統(tǒng)計(jì)分析。結(jié)果 共納入99例患者，監(jiān)測150例次伏立康唑血藥谷濃度，其中僅76.00%（114/150）達(dá)目標(biāo)范圍1~5.5 mg/L，<1 mg/L占13.33%（17/150），>5.5 mg/L占12.67%（19/150）；高齡患者（年齡 ≥ 60歲）伏立康唑血藥谷濃度與中青年組相比有統(tǒng)計(jì)學(xué)差異（P<0.05），多重線性回歸分析顯示，除年齡外（P=0.000），性別、體重、體重標(biāo)準(zhǔn)化劑量、APACHE2評分、總膽紅素及白蛋白對血藥谷濃度的影響均無統(tǒng)計(jì)學(xué)意義；是否使用質(zhì)子泵抑制劑與伏立康唑血藥谷濃度無顯著性差異（P=0.165），聯(lián)用泮托拉唑患者血藥濃度呈上升趨勢（P=0.054），聯(lián)用泮托拉唑與艾司奧美拉唑相比伏立康唑谷濃度比較有統(tǒng)計(jì)學(xué)差異（P=0.036）；伏立康唑達(dá)標(biāo)者與未達(dá)標(biāo)者病死率比較差異無統(tǒng)計(jì)學(xué)意義（χ²=0.059，P=0.809）。結(jié)論 伏立康唑血藥谷濃度個(gè)體差異大，因此臨床有監(jiān)測的必要，年齡、聯(lián)用質(zhì)子泵抑制劑對伏立康唑血藥谷濃度影響較大，制定給藥方案時(shí)需考慮這些因素的影響。

Objective To observe the changes in voriconazole plasma trough concentration in critical patients,and explore its optimal dosage. Methods A retrospective analysis was carried out in critical patients with voriconazole and voriconazole therapeutic drug monitoring (TDM) in intensive care unit (ICU) of the Affiliated Drum Tower Hospital of Nanjing University Medical School from December 2014 to December 2016.The patients' age, sex, dose, and other general information, voriconazole trough concentrations, influence of proton pump inhibitors (PPIs) on plasma trough concentrations, efficacy were analyzed retrospectively. Results 150 times of voriconazole plasma trough concentration in 99 patients were enrolled, and it was found that only 76.00% (114/150) reached the target concentration (1-5.5 mg/L), 13.33% (17/150) < 1 mg/L and 12.67% (19/150) > 20 mg/L. Significant difference was observed between old patients (≥ 60 years old) and other patients (< 60 years old) (P < 0.05), age (P=0.000) was found to be correlated to plasma trough concentrations by multiple linear regression analysis, but sex, body weight, weighted dose, APACHE2 score, total bilirubin and albumin don,t; there was no significant difference of plasma trough concentration of voriconazole between the use of PPIs, the concentration tended to increase with pantoprazole (P=0.054), and was statistically different compared with that of esomeprazole (P=0.036); There was no significant difference in mortality between patients with targeting trongh plasma concentrations and those without (χ²=0.059, P=0.809). Conclutions Voriconazole plasma trough concentration has great variation between individuals, so constant monitoring is necessary. Age and the combination of PPIs show a relatively significant influence on the serum trough concentrations,and they should be taken into consideration in dosage to be given.