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肾功能损害患者,药物排泄较慢,而调整药物剂量一直是医学界一个重要问题。Dettli提出:药物排泄率与肾小球滤过率(GFR)成一定比例,GFR下降时,药物剂量应按比例减少;并且与药物是经肾排泄抑或通过其他途径代谢或排泄有关。有时药物以多种方式排泄,则与GFR不成比例,主要见于尿pH改变时引起药物的非离子反渗率改变,以及当肾小管分泌的某药物与另一种药物出现竞争作用时。药物多数为弱酸或弱碱,在肾小管液中部分为水溶性离子,部分为结合的脂溶性酸或碱。当肾小管液中水盐重吸收后,药物在肾小管中浓度可超过血浓
Patients with impaired renal function, drug excretion slower, and adjust the drug dose has been an important issue in the medical profession. Dettli proposed that drug excretion rate is proportional to glomerular filtration rate (GFR) and that dose reduction should be proportional to GFR decline and related to drug excretion by the kidneys or metabolism or excretion by other routes. Sometimes drugs are excreted in a variety of ways, and GFR is disproportionate, mainly seen in urine pH changes caused by drug non-ionic reverse osmosis change, and when the tubular secretion of a drug and another drug competition. The majority of drugs are weak acid or weak base, part of the tubular fluid water-soluble ions, part of the combination of fat-soluble acid or alkali. When tubular fluid reabsorption, the concentration of drug in the renal tubules can exceed the blood concentration