估计严重病患创伤患者的测量肌素清除值,假定功能正常
Roland N Dickerson1, Delaney S Adams2, Julie E Farrar1
1Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, Memphis, TN, USA.
概括
常见的功能估计方程低估了在重症创伤患者中测量的肌素清除值,特别是那些干净度增强 (ARC) 患者. 这影响了这个脆弱人群的准确评估.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學.
- 关键护理医学 关键护理医学
- 创伤外科 手术 创伤外科
背景情况:
- 精确估计功能对于管理重症创伤患者至关重要.
- 像Cockcroft-Gault (CG) 和CKD-EPI这样的传统方程在这个群体中可能没有最佳的表现.
- 增加清除 (ARC) 在创伤患者中很常见,并可能影响药物剂量和结果.
研究的目的:
- 评估CG和2021年CKD-EPI方程的预测性能,以估计重症创伤患者的功能.
- 为了比较这些方程在患有和没有增强清除 (ARC) 的患者中的准确性.
主要方法:
- 对24小时尿液收集的成人创伤患者进行回顾性分析,以测量肌素清除率 (mCrCl).
- 纳入标准:假设正常的功能,mCrCl在服用后4-14天内.
- 排除标准:血清肌含量>1.5 mg/dL,需要进行透析.
主要成果:
- 无论是CG还是CKD-EPI等式,在整体队列中都显著低于预测的mCrCl (P < 0.001).
- 在ARC患者 (mCrCl>129毫升/分钟/1.73m2) 中持续存在低预测,估计中位数为160毫升/分钟 (CG) 和147毫升/分钟 (CKD-EPI).
- 在没有ARC的患者中,CKD-EPI方程式与CG相比显示出更高的精度 (P < 0.003).
结论:
- 估计功能的标准方程,包括CG和CKD-EPI,表明严重受伤患者的低估偏差.
- 这种低估在患有增强清除 (ARC) 的患者中尤为明显.
- 在创伤患者中对这些方程的临床使用需要仔细考虑,因为可能存在不准确性,特别是在ARC患者中.
相关概念视频
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01:23Renal Clearance
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01:07Determination of Renal Drug Clearance: Graphical and Midpoint Methods
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01:08Renal Drug Clearance: Comparison Between Renal Excretion Methods
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