论文部分内容阅读
目的:研究连续性静脉-静脉血液滤过(CVVH)对应用亚胺培南的多器官功能障碍综合征(MODS)患者药动学的影响,以指导临床合理用药。方法:根据患者肌酐清除率分为4组:Ccr<15mL.min-1(A组)、Ccr15～50mL.min-1(B组)、Ccr>50mL.min-1(C组)、Ccr>50mL.min-1未行CVVH治疗(D组),采用高效液相色谱法测定亚胺培南血药浓度,并计算药动学参数。结果:血浆亚胺培南在0.125～50mg.L-1范围呈良好线性关系,回收率大于98%,日内和日间RSD均小于10%;4组MODS患者血药峰浓度(Cmax)差别无统计学意义,与C组和D组相比,A组与B组血药谷浓度(Cmin)增高,总体清除率(CLT)降低,消除半衰期(t1/2)和药物平均滞留时间(MRT)延长,且与患者自身肾功能密切相关;与D组相比,C组CLT增加20%。接受CVVH治疗的3组患者t1/2与Ccr呈线性负相关,CLT与Ccr呈线性正相关。结论:CVVH可增加对亚胺培南体外清除,临床用药时应考虑多种影响因素,并监测血药浓度以提高疗效、减少不良反应。
Objective: To study the influence of continuous venovenous hemofiltration (CVVH) on the pharmacokinetics of imipenem in patients with multiple organ dysfunction syndrome (MODS) so as to guide clinical rational drug use. Methods: The patients were divided into 4 groups according to the creatinine clearance rate: Ccr <15mL.min-1 (group A), Ccr15-50mL.min-1 (group B), Ccr> 50mL.min- 50 mL.min-1 was not treated with CVVH (group D). The plasma concentration of imipenem was determined by HPLC, and the pharmacokinetic parameters were calculated. Results: The plasma imipenem showed a good linear relationship in the range of 0.125 ~ 50 mg.L-1, the recovery was more than 98%, and the intra-day and inter-day RSD were less than 10%. The difference of peak plasma concentration (Cmax) Compared with group C and group D, group C and group D increased plasma concentration (Cmin), reduced overall clearance (CLT), elimination half-life (t1 / 2) and mean drug retention time (MRT) Prolonged, and with the patient’s own renal function are closely related; compared with the D group, C group CLT increased by 20%. There was a linear negative correlation between t1 / 2 and Ccr in CVVH-treated patients, and a linear positive correlation between CLT and Ccr. Conclusion: CVVH can increase the clearance of imipenem in vitro. Many factors should be considered in the clinical medication, and the plasma concentration should be monitored to improve the curative effect and reduce the adverse reactions.