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目的:调研连续性肾脏替代治疗(CRRT)对危重症患者体内药量的影响,为个体化给药提供依据。方法:通过院内信息系统收集2012年1月至2015年3月ICU行CRRT患者性别、年龄、次数,CRRT前后血常规、生化指标资料,分析CRRT对患者基本情况影响;收集2014年7月至2015年3月ICU行CRRT患者超滤液,根据患者用药情况,选择奥美拉唑、奥硝唑、氟康唑、莫西沙星、利奈唑胺为目标药物,利用高效液相色谱(HPLC)测定含量,了解CRRT对患者体内药量的影响。结果:2012年1月至2015年3月共有150名患者在ICU接受CRRT治疗,其中男性94名,女性56名,平均年龄(65±19岁),行CRRT次数1~28次,涉及多系统疾病。CRRT前后患者肌酐、ALT、白细胞、血红蛋白呈下降趋势,Na~+、K~+、白蛋白变化不明显。2014年7月开始所收集的超滤液经HPLC测定,奥美拉唑、奥硝唑、利奈唑胺3种药物原型收集较少,有较低的超滤率;氟康唑及莫西沙星在所有患者中均显示高的超滤率,均超过50%。结论:接受CRRT治疗危重症患者肝肾功能及炎症状态均有不同程度改善。超滤液测定结果提示CRRT可能会增加氟康唑和莫西沙星药物清除率,有必要调整有关药物剂量;对奥美拉唑、奥硝唑、利奈唑胺影响较小。
Objective: To investigate the effect of continuous renal replacement therapy (CRRT) on the dose of critically ill patients and provide the basis for individualized administration. Methods: The data of CRRT patients’ sex, age, frequency, blood routine and biochemical indexes before and after CRRT from January 2012 to March 2015 were collected through hospital information system to analyze the impact of CRRT on the basic situation of patients. From July 2014 to 2015 March 2016 ICU line CRRT patients with ultrafiltrate, according to the patient medication, select omeprazole, ornidazole, fluconazole, moxifloxacin, linezolid as the target drug, using high performance liquid chromatography (HPLC) determination Content, to understand the impact of CRRT on the patient’s dose. RESULTS: From January 2012 to March 2015, a total of 150 patients were treated with CRRT in the ICU, 94 males and 56 females, with an average age of 65 ± 19 years. The number of CRRTs was 1 to 28 times and involved multiple systems disease. Creatinine, ALT, leukocyte and hemoglobin in patients before and after CRRT showed a decreasing trend, while Na ~ +, K ~ + and albumin did not change significantly. The collected ultrafiltrate from July 2014 was determined by HPLC. Omeprazole, ornidazole and linezolid were less collected and the ultrafiltration rate was lower. Fluconazole and moxifloxacin In all patients showed high rates of ultrafiltration, both exceeding 50%. Conclusion: The liver and kidney function and inflammatory status of critically ill patients treated with CRRT are improved to some extent. The results of ultrafiltration showed that CRRT may increase the clearance rate of fluconazole and moxifloxacin, and it is necessary to adjust the dosage of the drug. The effects on omeprazole, ornidazole and linezolid are minor.