在ECMO支持的重症成年人中优化药物治疗:叙述性审查和临床指南
Abraham Rocha-Romero1, Jose Miguel Chaverri-Fernandez2, Fianesy Chaves-Fernández3
1Pharmacy Department, Clínica Bíblica, San José 1307-1000, Costa Rica.
Pharmacy (Basel, Switzerland)
|November 24, 2025
概括
身体外膜氧化 (ECMO) 改变了严重病情的成年人的药物药理动力学 (PK) 和药理动力学 (PD). 使用治疗药物监测的个性化剂量对于优化ECMO支持期间的药物治疗至关重要.
科学领域:
- 关键护理医学 关键护理医学
- 临床药理学 临床药理学
- 药理动力学和药理动力学
背景情况:
- 身体外膜氧化 (ECMO) 对严重的心脏/呼吸系统衰竭至关重要.
- ECMO电路和危急疾病改变了药物的药理动力学 (PK) 和药理动力学 (PD).
- 在ECMO患者中优化药物治疗存在重大挑战.
研究的目的:
- 审查有关ECMO相关PK/PD变化的当前临床证据.
- 为成年ECMO患者的药物剂量和监测提供实际指导.
- 综合ECMO中常用的治疗类别的数据.
主要方法:
- 从2025年1月到5月进行了结构化的文献搜索.
- 搜索的数据库包括PubMed/MEDLINE,EMBASE,Scopus和其他数据库.
- 包括的研究包括成人临床试验,观察性研究,评论和指导方针.
主要成果:
- 水友性药物 (例如β-乳酸,氨基糖化物) 显示了极小的ECMO特异性PK变化.
- 脂友性药物 (例如芬太尼,普罗波) 呈现出显著的电路吸附和可变性.
- 对一些药物类别 (如神经肌肉阻断剂和抗病毒药物) 的数据有限.
结论:
- 个性化剂量对于优化ECMO患者的药物治疗至关重要.
- 治疗药物监测 (TDM) 和PK原则对于指导治疗至关重要.
- 对于缺乏ECMO特定数据的特定药物类别需要进行进一步的研究.
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