在重症监护病人的连续脏替代疗法期间追求真实的万科米辛清除:是否有足够的目标实现?
Tim J L Smeets1, Hilde R H de Geus2, Anouk Rietveld1
1Department of Hospital Pharmacy, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.
在接受连续脏替代疗法 (CRRT) 的重症监护病房患者中,一半的患者在24小时内出现了治疗次的万科米辛水平. 在CRRT期间优化万科米辛剂量对于有效治疗至关重要.
科学领域:
- 药理学 药理学是指药理学的学科.
- 临界护理医学 临界护理医学
- 腎臟病學 (nephrology) 是一種醫學.
背景情况:
- 范科米对于在重症监护室 (ICU) 治疗格拉姆阳性细菌感染至关重要.
- 达到康明的药理动力学/药理动力学 (PK/PD) 指数 (≥400-600小时*毫克/升) 的目标至关重要,通常需要20-25毫克/升的血度.
- 危急疾病和连续置换疗法 (CRRT) 引入了显著的药物动力学变异性,复杂化了万科米辛的剂量.
研究的目的:
- 确定在接受CRRT的成年ICU患者24小时内达到目标度 (20-25毫克/升) 的患病率.
- 评估在第二和第三天达到万科米辛标的水平.
- 通过CRRT和残留尿解来计算万科米辛清除率 (CL).
主要方法:
- 一项前性观察性研究对成年ICU患者进行了研究,在CRRT时至少24小时接受连续的万科米辛输液.
- 在血液气体和透析液样本中测量了万科米辛水平,在可能的情况下收集尿液样本.
- 通过CRRT计算的米素清除率是使用考虑停机时间和过器通透度的方法来计算的.
主要成果:
- 50%的患者 (n=10) 在24小时内康胺度低于20毫克/升.
- 只有30%的患者达到20-25毫克/升的康明的目标度.
- 在第二天和第三天,尽管有治疗药物监测 (TDM),但治疗后和治疗后的万科米辛水平仍然存在.
- 当考虑停机时间和过器通透度时,计算的米素清除值较低.
结论:
- 在接受CRRT的研究中的ICU患者中,一半的患者在开始治疗后24小时表现出治疗次的万科米辛度.
- 对于接受CRRT的患者来说,要确保治疗疗效,需要优化万科米辛的剂量.
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