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目的探讨接受连续性肾脏替代疗法(CRRT)治疗的重症感染患者,在连续性静脉-静脉治疗血液滤过(CVVH)模式下应用亚胺培南治疗时其血药浓度的达标情况。方法采用已建立的HPLC法测定17例接受CRRT的重症感染患者在CVVH模式下应用亚胺培南治疗时谷浓度,考察药动学/药效学靶标100%T>MIC和100%T>4MIC的达标情况。结果 17例接受亚胺培南血药浓度监测的患者,其APACHEⅡ评分均值为27分。当MIC值为1 mg·L~(-1)时,以100%T>MIC为靶值,日总剂量1、1.5、2 g组的达标率分别为86%、67%和100%。以100%T>4MIC为靶值,日总剂量1、1.5、2 g组的达标率分别为0、33%和57%。结论接受CRRT治疗的重症感染患者,其亚胺培南给药剂量不能按推荐剂量给药,应按血药浓度监测结果进行调整,以获得更好的治疗效果。
Objective To investigate the compliance of plasma concentrations of imipenem in patients with severe infections treated with continuous renal replacement therapy (CRRT) under continuous intravenous-venous hemofiltration (CVVH). Methods The established HPLC method was used to determine the trough concentrations of imipenem in 17 CRRT-infected patients undergoing CVVH. The pharmacokinetic / pharmacodynamic targets of 100% T> MIC and 100% T> 4MIC The compliance of the situation. Results 17 patients receiving imipenem plasma concentration monitoring, the APACHE Ⅱ score of 27 points. When the MIC value was 1 mg · L -1, the target rates of total daily doses of 1, 1.5 and 2 g were 86%, 67% and 100%, respectively, with 100% T> MIC as the target. With 100% T> 4MIC as the target value, the compliance rates of total daily doses of 1, 1.5 and 2 g were 0, 33% and 57% respectively. Conclusion Patients receiving severe CRRT infection should not receive the recommended dose of imipenem, and should be adjusted according to the result of blood concentration monitoring in order to obtain a better therapeutic effect.