高强度连续脏替代疗法中的万科米辛剂量:一项回顾性队列研究
Nina Srour1, Chelsea Lopez1, Luma Succar1
1Department of Pharmacy, Houston Methodist Hospital, Houston, Texas, USA.
Pharmacotherapy
|July 17, 2023
概括
对于接受高强度连续脏替代疗法 (CRRT) 的重症患者来说,需要更高的范胺剂量 (≥15 mg/kg/day),以达到治疗范胺AUC/MIC目标. 这种增强的剂量策略提高了范科米辛在这个人群中的有效性和安全性.
科学领域:
- 药理动力学 药理动力学
- 关键护理医学 关键护理医学
- 腎臟病學 (nephrology) 是一種醫學專業.
背景情况:
- 范科米辛血清度与连续脏替代疗法 (CRRT) 强度相反相关,特别是透析液流量 (DFR).
- 在高强度CRRT (DFR>30毫升/公斤/小时) 中,最优的万科米辛剂量缺乏可靠的证据.
- 从低谷基转向曲线下面面积 (AUC) 基的万科米辛剂量转移需要了解CRRT对AUC/MIC目标的影响.
研究的目的:
- 在接受高强度CRRT的患者中评估万科米辛剂量策略.
- 评估当前剂量方案的药理动力学目标的实现情况.
- 确定最佳的万科米辛剂量,以在这个人群中实现目标AUC/MIC比率.
主要方法:
- 对接受高强度CRRT的成年患者进行了回顾性队列研究.
- 高强度CRRT定义为DFR≥3 L/h和>30 mL/kg/h.
- 患者分为传统 (15毫克/公斤/天) 和增强 (≥15毫克/公斤/天) 范胺剂量组.
- 主要结局:在第一个万科米辛水平时,达到稳定状态AUC24/MIC≥400 mg*h/L的患者百分比.
主要成果:
- 增强剂量组实现了主要终点的频率 (74%) 比传统组 (54%) (p=0.029).
- 在增强组中观察到更高的治疗性万科米辛最低水平 (10-20μg/mL) (66.7%与45%相比,p=0.013).
- 增加DFR与需要更高的万科米辛剂量 (高达27 mg/kg/day) 相关联,以达到治疗目标.
结论:
- 这项研究是首次检查CRRT强度对万科米辛AUC/MIC的影响.
- 建议在高强度CRRT患者中使用≥15mg/kg/天的万科米辛剂量,以实现早期的治疗目标.
- 增强的万科米辛剂量策略对于优化该患者群的疗效和安全至关重要.
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