重症肺部感染患者连续性肾替代治疗时比阿培南的药效学研究.docVIP

重症肺部感染患者连续性肾替代治疗时 比阿培南的药效学研究 肖仲祥 陈朴 邵传锋 戈宏磊 赵乐萍 胡国新 乐清市人民医院临床药学室乐清市人民医院重症医 学科温州医科大学药学院药理教研室 摘要： 目的探讨重症肺部感染患者在连续性肾替代治疗(CRRT)时应用比阿培南的药 效学。方法 选择2016年1月-2016年10月接受CRRT治疗的重症肺部感染患者 20例，治疗前收集患者的下呼吸道痰液标本，采用琼脂稀释法检测各抗菌药物 的敏感试验;纳入对比阿培南敏感的患者20例，共检出26株致病菌，选择比阿 培南0. 3q 12h或0. 3q 8h抗感染治疗，疗程10,4d,通过DAS 3. 0分析患者的药 动学数据，结合不同细菌的M1C值进行蒙特卡洛模拟，计算两种方案的%TMIC 比值和达标概率PTA;同时，评价患者的细菌学疗效和临床疗效。结果20例重症 肺部感染患者接受CRRT治疗时比阿培南的药动学参数tl/2 (71. 36±40.41) min、Vd (11.75±3. 86) L;针对不同细菌的MIC值,当MICW2时，两种方案 的％TMIC 均40%,且 PTA90%,当 MIO4 时，只有 0. 3q8h 给药方案%TMIC40%, 而当M1CN8时，两种方案均达不到给药目标。20例患者治疗有效率为85. 00%, 细菌清除率为65. 4%o结论 比阿培南应用于敏感菌引起的CRRT重症肺部感染患 者体内是安全有效的，但考虑接受CRRT患者的个体差异较正常患者更大，因此, 建议对患者进行个体化治疗。 关键词： 比阿培南;连续性肾脏替代治疗;肺部感染;药效学; 作者简介：陈朴，E-ma订：154579741@ 收稿日期：2017-08-11 基金：温州市公益性科技计划基金资助项目( Pharmacodynamics of biapenem in severe pulmonary infection patients with continuous renal replacement therapy XIAO Zhong-xiang CHEN Pu SHAO Chuan-feng GE Hong-lei ZHAO Le-pin HU Guo-xin Yueqing People s Hospital of Zhejiang Province; Abstract： OBJECTIVE To investigate the pharmacodynamics of biapenem in severe pulmonary infection patients with continuous renal replacement therapy (CRRT) . METHODS A total of 20 cases of severe pulmonary infection patients who received CRRT treatment from Jan. 2016 to Oct. 2016 were selected to collect sputum samples from lower rcspiratory tract before treatment, and the drug susceptibility testing was performed by agar dilution method.Totally 20 patients with 26 strains of pathogenic biapenem sen si tive bacteria were selected to apply biape nemO. 3 ql2 hor 0. 3 q8 hanti infection treatment for 104 days, pharmacokinetic parameters were calculated with DAS3. 0 program, and two therapeutic regimens were simulated with the Monte Carlo simulation to calculate %TM1C and PTA. At the same time, the bacteriological efficacy and clinical efficacy of the patients were evaluated. RESULTS The bi ape nem pharmacokinetic parameters of tl/2 was (71. 36+40. 41) min, and Vd was (11. 75±3. 86) L. According