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目的：调查万古霉素在老年住院患者中的应用情况。方法收集1011年9月至1013年11月在北京大学第一医院、卫生部北京医院、首都医科大学附属北京朝阳医院、首都医科大学宣武医院、解放军总医院等5家医院住院期间应用过万古霉素、年龄≥60岁且病历资料完整者的临床资料，将患者分为肾功能正常与肾功能不全1组，主要就万古霉素用药情况（给药方案、药物利用情况和血药浓度监测）、临床疗效以及药物对患者肾功能影响等进行回顾性分析。药物利用情况以药物利用指数（DUI）反映；肾功能检测指标为血清肌酐（Scr）、尿素氮（BUN）和内生肌酐清除率（Ccr）。结果共149例患者纳入分析，男性60例，女性89例；年龄60~91（76±7）岁。肾功能正常组87例，肾功能不全组61例。万古霉素给药方案肾功能正常组应用最多者为0.50 g，1次/11 h （19/87，33.33%）；肾功能不全组为0.50 g，1次/d（30/61，48.39%）。万古霉素总用药量为1135.15 g，总用药时间为1919.5 d，DUI 为0.56。149例患者中进行血药浓度监测者111例（74.50%），肾功能正常组与肾功能不全组行血药浓度监测者占比差异无统计学意义[70.11%（61/87）比80.65%（50/61），χ1=1.113，P=0.146]。行血药浓度监测者均监测了万古霉素谷浓度，监测峰浓度者7例。万古霉素谷浓度以﹤10 mg/L者占比最大，肾功能正常组和肾功能不全组分别为30例（49.18%）和15例（50.00%）。各组间数据差异均无统计学意义（χ1=1.16，P =0.54）。149例患者用药前后Scr[（117±79）μmol/L比（119±81）μmol/L]、BUN[（10.5±5.7）mmol/L比（11.5±8.0）mmol/L]和Ccr[（69±37）ml/min比（67±36）ml/min]比较，差异均无统计学意义（均P﹥0.05）。肾功能正常组和肾功能不全组患者用药前后 Scr[（59±16）μmol/比（70±30）μmol/L，（189±110）μmol/L 比（103±113）μmol/L]、BUN[（7.4±3.5）mmol/L 比（9.1±5.8）mmol/L，（14.8±6.5）mmol/L比（17.4±9.0）mmol/L]和Ccr[（107±19）ml/min比（96±16）ml/min，（44±30）ml/min比（33±16）ml/min]比较，差异也均无统计学意义（均P﹥0.05）。结论万古霉素在老年住院患者中的应用相对谨慎。应用该药时可根据血药浓度和肾功能监测结果及时调整给药方案，实行个体化给药，提高药物有效性和安全性。“,”Objective To investigate the application of vancomycin in elderly inpatients. Methods The clinical data of elderly inpatients(≥60 years ) treated with vancomycin from September 1011 to November 1013 in 5 hospitals including Peking University First Hospital,Beijing Hospital,Beijing Chao-Yang Hospital,Xuanwu Hospital of Capital Medical University,and Chinese PLA General Hospital were collected. All patients were divided into normal renal function group and renal insufficiency group. The application( dosage regimen,drug utilization situation,and therapeutic drug monitoring ) and clinical efficacy of vancomycin and its effects on renal function in elderly patients were retrospectively analyzed. Drug utilization index( DUI)reflected the drug utilization situation. And parameters of renal function includedserum creatinine(Scr),blood urea nitrogen(BUN)and creatinine clearance rate(Ccr). Results A total of 149 patients were enrolled in this study comprising 60 males and 89 females with age of 60-91(76 ± 7)years. There were 87 cases in the normal renal function group and 61 cases in renal insufficiency group. The most widely used regimen of application of vancomycin was 0. 50 g once every 11 hours in the normal renal function group(19/87,33. 33%)and 0. 50 g once daily in the renal insufficiency group(30/61, 48. 39%). The total dosage and time of using vancomycin were respectively 1 135. 15 g and 1 919. 5 d. And the DUI was 0. 56. Among the 149 patients,111 cases(74. 50%)underwent blood concentration monitoring and there were no statistically significant differences in constituent ratio of undergoing blood concentration monitoring between the normal renal function group and the renal insufficiency group[70. 11%(61/87)vs. 80. 65%(50/61),χ1 =1. 11,P=0. 15]. In all patients undergoing blood concentration monitoring,trough concentration was detected and in 7 patients peak concentration was detected. The number of cases whose trough concentrations ﹤10 mg/L was 30(49. 18%)and 15 cases(50. 00%)in the normal renal function group and the renal insufficiency group,respectively,and there were no statistically significant differences (χ1 =1. 16,P =0. 54 ). The differences between before and after administration of vancomycin in Scr [(117 ± 79)μmol/L vs.(119 ± 81)μmol/L],BUN[(10. 5 ± 5. 7)mmol/L vs.(11. 5 ± 8. 0)mmol/L], and Ccr[(69 ± 37)ml/min vs.(67 ± 36)ml/min]in all the 149 patients were not statistically significant (all P﹥0. 05). The differences between before and after administration of vancomycin in Scr[(59 ± 16)μmol vs.(70 ± 30)μmol/L,(189 ± 110)μmol/L vs.(103 ± 113)μmol/L],BUN[(7. 4 ± 3. 5)mmol/L vs.(9. 1 ± 5. 8)mmol/L,(14. 8 ± 6. 5)mmol/L vs.(17. 4 ± 9. 0)mmol/L],and Ccr[(107 ± 19)ml/min vs.(96 ± 16)ml/min,(44 ± 30)ml/min vs.(33 ± 16)ml/min]in the normal renal function group and the renal insufficiency group were not statistically significant(all P﹥0. 05). Conclusions The use of vancomycin in elderly inpatients was relatively cautious. Dosage regimen should be adjusted timely according to the results of blood concentration and renal function tests and individualized administration should be adopted in order that the efficacy and safety could be improved.