皮佩拉西林剂量可以根据重症监护室患者的功能进行预测吗? 三种不同配方的比较
Sophie Magréault1,2, Takoua Khzouri3, Khalil Chaïbi4
1Université Sorbonne Paris Nord et Université Paris Cité, Inserm, IAME, Bobigny, France.
Therapeutic drug monitoring
|September 5, 2025
概括
在重症监护室中,需要根据功能调整皮佩拉西林的剂量,以防止暴露不足,特别是在清晰度增加的患者中. 然而,显著的变异性需要治疗药物监测以获得最佳的piperacillin治疗.
科学领域:
- 药理动力学和药理动力学
- 危急护理医学
- 肝脏病学
背景情况:
- 在重症监护室 (ICU) 患者中,清量的增加与皮佩拉西林暴露不足有关.
- 在ICU环境中基于功能的最佳piperacillin剂量策略尚不清楚.
- 之前的研究表明,危急病患者的皮佩拉西林水平可能不足.
研究的目的:
- 使用不同的功能公式,评估皮佩拉西林暴露不足和过度暴露的可预测性.
- 评估常规piperacillin治疗方案对有功能变化的ICU患者的适用性.
- 确定不同脏清除群体治疗度所需的理论piperacillin剂量.
主要方法:
- 在接受连续输液的159名ICU患者中,对平稳状态piperacillin度 (Css) 的回顾性分析.
- 使用Cockcroft-Gault,MDRD和CKD-EPI 2021公式进行功能估计.
- 接受器操作特征 (ROC) 曲线分析,以评估功能配方与皮佩拉西林暴露之间的关联.
主要成果:
- 考克克罗夫特-高尔特方程对皮佩拉西林暴露不足 (切线值为128毫升/分钟) 和过度暴露 (切线值为81毫升/分钟) 的预测结果略有改善.
- 由于肌素清除率从60 - 90毫升/ 分升至> 160毫升/ 分,皮佩拉西林的低暴露率从23%增加到88%.
- 理论上每日皮佩拉西林剂量随功能显著增加,但个体间的差异很大.
结论:
- 每日皮佩拉西林剂量的逐渐增加得到了功能的支持.
- 由于piperacillin的药理动力学具有显著的个体间变异性,因此无法先验地提供强有力的剂量建议.
- 治疗药物监测对于优化ICU患者的piperacillin治疗至关重要.
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