败血症对抗菌药物药动学的影响机制及其对个体化用药的指导意义  

Pathophysiological Effects of Sepsis's on Pharmacokinetics of Antimicrobial Drugs and Its Significance in Individualized Antimicrobial Therapy

作　　者：周佳[1] 蔡和平[2] 王学彬[2] 王卓[2] 

机构地区：[1]上海交通大学医学院附属新华医院药剂科,上海200092 [2]第二军医大学附属长海医院药剂科,上海200433

出　　处：《药品评价》2013年第8期27-31,共5页Drug Evaluation

摘　　要：败血症会改变内环境,从而影响药物药动学行为。本综述从药动学角度出发,总结分析败血症中相关病理生理因素对药物体内吸收,分布,代谢,排泄等药动学环节的影响,并且结合各类抗菌药物自身药动学特点,总结其在败血症患者体内药动学变化及剂量调节相关信息。为败血症治疗中预测抗菌药物药动学行为,合理解释治疗药物监测结果,优化治疗方案提供参考。氨基糖苷类、糖肽类、β-内酰胺类等抗菌药物在败血症患者间或个体内存在较大药动学差异及血药浓度波动,需要个体化剂量调节。万古霉素在败血症无器官衰竭时表观分布容积和清除率增大,需要考虑高于常规给药剂量,具体优化剂量方案尚未定论。Sepsis accompanied by profound changes in the body may alter the pharmacokinetics of different drugs. Hydrophilic antimicrobials, such as aminoglycosides, glycopeptides and β-lactams are at much higher risk of inter- and intra- individual pharmacokinetic variations than lipophilic antimicrobials. Significant frequent fluctuations of plasma concentration may require appropriate dosage adjustments. Aminoglycosides display an increased volume of distribution in sepsis, resulting in decreased peak serum concentrations; however, reduced clearance by renal dysfunction would increase the likelihood of toxicity. β-Lactams have increased Vd and renal clearance which would require an increased dose or continuous infusion. Furthermore, dose reduction may be required if renal impairment occurs. Vancomycin probably requires higher dose than conventionally recommended dose because of increased Vd and clearance during sepsis with no organ dysfunction. However, optimal dosing regimen remains unresolved.

关 键 词：败血症 抗菌药物 药代动力学 氨基糖苷类抗菌药物 β内酰胺类抗菌药物 血药浓度监测 

分 类 号：R96[医药卫生—药理学]