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抗生紊在临床应用中,除存在适应症不对路,预防用药量过大,无原则合并用药等方面问题外,在用药方式上也存在较多问题。首先,静脉输注抗生素时,常将一日剂量1次给予,造成血药浓度波动较大;一日中低于有效血药浓度的时间过长,例如,庆大霉素剂量在12～32万单位/日,滴速为4～16万单位/小时,一日1次输注时,低于2μg/ml的时间可长达13.36～19.51小时,而剂量为24～32万单位/日,滴速为8～16万单位/小时,1次输注时,其峰值超过12μg/ml~([1])。红霉素剂量为1g/日、滴速为166mg/小时滴注时,24小时内有效血药浓度维持时间仅11小时,而峰值又往往过高~([2])。这样既影响疗效,且易于产生毒副反应。如我院泌尿科1例全膀胱切除术后绿脓肝菌败血症患者,每日使用庆大霉素24万单位,一日1次静脉输注共3日无效,日剂量仍为24万单位,改为每日2次输注后病员热退,3次血培养转阴,最后痊愈出院。
Antibiotic disorders in clinical applications, in addition to the existence of indications wrong way, the prevention of excessive dosage, the principle of combination of medication and other issues, there are also many problems in the way of medication. First of all, intravenous infusion of antibiotics, often one dose a day, resulting in large fluctuations in blood concentration; one day is lower than the effective plasma concentration for too long, for example, the dose of gentamicin at 12 to 320,000 units / Day, the drip rate of 4 to 160,000 units / hour, 1 day infusion, less than 2μg / ml of time up to 13.36 ~ 19.51 hours, and the dose of 24 to 320,000 units / day, drip rate For 8 to 160,000 units / hour, the peak value of more than 12μg / ml ~ ([1]). Erythromycin dose of 1g / day, the drip rate of 166mg / hour infusion, the effective blood concentration within 24 hours to maintain time of only 11 hours, while the peak is often too high ~ ([2]). This will not only affect the efficacy, and prone to toxic side effects. Such as urology in our hospital 1 case of cystectomy after the greenpeak liver sepsis patients, daily use of gentamicin 24 million units, 1 intravenous infusion of a total of 3 days a day, the daily dose is still 240,000 units, Changed to 2 times a day after the infusion of patients with fever, blood culture 3 negative, finally discharged.