在危急疾病后估计功能错误对药物剂量类别的时间影响
Ryusei Mikami1,2, Shungo Imai3, Mineji Hayakawa4
1Graduate School of Life Science, Hokkaido University, Sapporo, Japan.
British journal of clinical pharmacology
|August 26, 2025
概括
在重症患者中,使用Cockcroft-Gault (CG),MDRD和CKD-EPI等方程估计功能可能导致药物剂量不准确. 这些方程显示了随着时间的推移而增加的轨迹,与测量的肌素清除率 (Clcr) 不同.
科学领域:
- 肝脏病学
- 危急护理医学
- 临床药理学
背景情况:
- 准确评估功能对于重症患者的药物剂量至关重要.
- 肌素清除 (Clcr) 是功能的一个关键指标.
- 估计方程如Cockcroft-Gault (CG),脏疾病饮食改变 (MDRD) 和慢性脏疾病流行病学协作 (CKD-EPI) 是常用的,但可能有局限性.
研究的目的:
- 将CG,MDRD和CKD-EPI方程的轨迹与重症患者的测量Clcr进行比较.
- 评估这些方程差异对药物剂量类别的时间影响.
主要方法:
- 使用了5355个患者病后病期的数据.
- 使用线性混合模型来估计功能方程的轨迹.
- 根据估计的方程与测量的Clcr比较的药物剂量类别.
主要成果:
- 测量的Clcr在28天内变化很小 (- 0.02毫升/分钟/1.73毫米/天).
- 估计的方程显示了依赖时间的增加:CG (+2.00),MDRD (+1.50) 和CKD-EPI (+0.77 mL/分钟/1.73 m2/天).
- 超过一半的估计方程导致与测量Clcr的差异,导致药物剂量类别的改变 (低估早期,高估晚期).
结论:
- 基于肌素的估计方程显示,在重症患者中,随着时间的推移,肌素的轨迹会增加.
- 这些差异导致超过50%的重症监护日错误的药物剂量类别.
- 临床实践应仔细考虑这些方程在重症监护机构的药物管理方面的局限性.
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