论文部分内容阅读
目的研究连续性静脉-静脉血液滤过(CVVH)对应用头孢他啶(CAZ)的多器官功能衰竭(MOF)患者药代动力学影响。方法根据患者内生肌酐清除率(Ccr)将2006年1月至2008年12月江苏省南通大学附属医院住院的18例MOF患者分为3组:Ccr<15mL/min(A组)、Ccr15～50mL/min(B组)、Ccr>50mL/min(C组),采用高效液相色谱法测定CAZ血药浓度,并计算药代动力学参数。结果血清CAZ最低检测浓度为0.5mg/L,在2～200mg/L的浓度范围呈良好线性关系,回收率大于98%,日内和日间变异系数均小于10%;接受CVVH治疗的3组MOF患者血药峰浓度(Cmax)差异无统计学意义,与C组相比,A组与B组血药谷浓度(Cmin)增高[(36.01±9.36)mg/L,(19.81±2.36)mg/L对(8.33±3.75)mg/L,P<0.05],总体清除率(ClT)降低[(20.98±6.02)mL/min,(33.33±9.08)mL/min对(97.28±14.35)mL/min,P<0.05],消除半衰期(t1/2)[(8.49±1.41)h,(4.46±0.64)h对(2.13±0.34)h,P<0.05]和药物平均滞留时间(MRT)[(11.99±1.87)h,(5.65±0.35)h对(2.96±0.44)h,P<0.05)]延长,且与患者自身肾功能密切相关;A组稳态分布容积(Vss)较C组减小[(12.55±2.42)L比(17.67±2.31)L,P<0.05]。t1/2与Ccr呈负相关性,ClT与Ccr呈正相关性。结论 CVVH可增加MOF患者对CAZ的体外清除,临床用药时应考虑多种影响因素,并监测血药浓度以提高疗效、减少副反应。
Objective To investigate the pharmacokinetics of continuous venovenous hemofiltration (CVVH) in patients with multiple organ failure (MOF) using ceftazidime (CAZ). Methods According to the endogenous creatinine clearance (Ccr), 18 patients with MOF admitted to Nantong University Affiliated Hospital of Jiangsu Province from January 2006 to December 2008 were divided into three groups: Ccr <15mL / min (group A), Ccr15 ~ 50 mL / min (group B) and Ccr> 50 mL / min (group C). The plasma concentration of CAZ was determined by HPLC and the pharmacokinetic parameters were calculated. Results The lowest serum concentration of CAZ was 0.5 mg / L, with a good linearity in the concentration range of 2 ~ 200 mg / L. The recovery rate was more than 98% and the intra-and inter-day CVs were less than 10%. Three groups of CVFH MOF There was no significant difference in peak plasma concentration (Cmax) between patients in group A and group B compared with group C [(36.01 ± 9.36) mg / L, (19.81 ± 2.36) mg / (P <0.05), and the overall clearance rate (ClT) was significantly lower than that of the control group (8.33 ± 3.75 mg / L vs 8.33 ± 3.75 mg / L vs20.38 ± 14.35 mL / min vs33.33 ± 9.08 mL / min (P <0.05), the elimination half-life (t1 / 2) [(8.49 ± 1.41) h, (4.46 ± 0.64) h vs. (2.13 ± 0.34) h, P < ± 1.87) h, (5.65 ± 0.35) h vs (2.96 ± 0.44) h, P <0.05)], and was closely related to the patient’s renal function. The steady-state distribution volume (Vss) (12.55 ± 2.42) L ratio (17.67 ± 2.31) L, P <0.05]. t1 / 2 was negatively correlated with Ccr, and ClT was positively correlated with Ccr. Conclusions CVVH can increase the in vitro clearance of CAZ in patients with MOF. Various factors should be considered in the clinical medication, and blood concentration should be monitored to improve curative effect and reduce side effects.