AKI柳长福创新.pptVIP

延长给药间隔 间隔= 正常间隔 ? Q 减少每次用药剂量 .. 剂量= 正常剂量 × Q 同时减少剂量和延长间隔 计算每日总剂量 选定给药间隔 计算每次剂量 每次剂量=(正常剂量?Q?选定间隔)/正常间隔 Pharmacokinetic Factors 抗菌药物药代动力学发生改变 Vd↑、药物血清浓度↓ AKI导致的液体超负荷 疾病危重导致强制性毛细血管漏 亲水性药物受影响：B-lactams，aminoglycosides 蛋白结合率下降 疾病状态：尿毒症、肝硬化、肾病综合征、烧伤等 竞争性置换结合的药物 pH、肝素、游离脂肪酸 如 salicylate 、sulfonamide 肾脏清除率下降 (受RRT的影响) Pharmacokinetic Factors Vd 决定首剂或负荷剂量 维持剂量取决于总药物清除率 非RRT清除 残余肾功能 肝脏清除率 CRRT清除 CRRT模式：CVVH、CVVHD等 CRRT剂量、前稀释或后稀释 滤膜：孔径、吸附能力 Sc Equations for calculating CRRT clearance from the first principles Sc的计算方法 (主要取决于蛋白结合率) Sc=1 – PB (可变的) 影响因素 膜材料 药物-膜相互作用 孔道特性 CVVH (前稀释) 如何计算校正因子 (CF) CRRT清除率(后稀释)=Qf × Sc CF = Qb /(Qb + Qrep) Qb ：血流速率；Qrep：置换液速率 Equations for calculating CRRT clearance from the first principles Kill characteristics of different antibacterials and pharmacokinetic targets associated with optimal bacterial killing 治疗原则：疗效最大化，尽量减少抗生素阻抗 和不良反应 设定抗生素治疗目标 Pharmacokinetic data for antibacterials commonly used in intensive care in patients receiving CRRT Pharmacokinetic data for antibacterials commonly used in intensive care in patients receiving CRRT Pharmacokinetic data for antibacterials commonly used in intensive care in patients receiving CRRT Pharmacokinetic data for antibacterials commonly used in intensive care in patients receiving CRRT Calculation of antibacterial doses based on first principles Non-CRRT clearance is the sum of nonrenal clearance plus residual renal clearance. Cl tot = Total clearance. Calculation of amikacin dose for empirical non-enterobacteriaceae nosocomial sepsis for a 70-kg patient with anuric acute renal failure onCVVH using an AN69 filter and with targeted UFR 35 ml/kg/h 已知数据 Vd：33L Sc：0.62 Non-CRRT clearance：23ml/min 预计目标值 Cmax/MIC=8 Calculation of meropenum dose for empirical non-enterobacteriaceae nosocomial sepsis for a 70-kg patient with anuric acute renal failure onCVVHusing an AN69 filter and with