连续性肾脏替代治疗对危重症患者药物体内清除的影响  

Effect of continuous renal replacement therapy on drug elimination in critically ill patients

作　　者：王心慧[1] 刘皈阳[1] 周亮[1] 李翔[1] 冯春景[1] 高磊[1] 王明媚[1] 张鑫[1] 卫晋菲[1] 

机构地区：[1]解放军总医院第一附属医院药剂药理科,北京100048

出　　处：《临床药物治疗杂志》2016年第2期48-52,共5页Clinical Medication Journal

基　　金：北京药学会基金2014年研究项目

摘　　要：目的:调研连续性肾脏替代治疗(CRRT)对危重症患者体内药量的影响,为个体化给药提供依据。方法:通过院内信息系统收集2012年1月至2015年3月ICU行CRRT患者性别、年龄、次数,CRRT前后血常规、生化指标资料,分析CRRT对患者基本情况影响;收集2014年7月至2015年3月ICU行CRRT患者超滤液,根据患者用药情况,选择奥美拉唑、奥硝唑、氟康唑、莫西沙星、利奈唑胺为目标药物,利用高效液相色谱(HPLC)测定含量,了解CRRT对患者体内药量的影响。结果:2012年1月至2015年3月共有150名患者在ICU接受CRRT治疗,其中男性94名,女性56名,平均年龄(65±19岁),行CRRT次数1~28次,涉及多系统疾病。CRRT前后患者肌酐、ALT、白细胞、血红蛋白呈下降趋势,Na^+、K^+、白蛋白变化不明显。2014年7月开始所收集的超滤液经HPLC测定,奥美拉唑、奥硝唑、利奈唑胺3种药物原型收集较少,有较低的超滤率;氟康唑及莫西沙星在所有患者中均显示高的超滤率,均超过50%。结论:接受CRRT治疗危重症患者肝肾功能及炎症状态均有不同程度改善。超滤液测定结果提示CRRT可能会增加氟康唑和莫西沙星药物清除率,有必要调整有关药物剂量;对奥美拉唑、奥硝唑、利奈唑胺影响较小。Objective： To investigate the effect of continuous renal replacement therapy（CRRT） on drug elimination in critically ill patients to provide evidence for individual administration. Methods： During the period from January 2012 to March 2015, gender, ages, times of CRRT, blood routine, biochemical indexes（before and after CRRT） of patients in ICU, were collected by HIS system, and the effect of CRRT on basic conditions of the patients was analyzed; from July 2014 to March 2015, ultrafiltrate liquids in patients who received CRRT in ICU were collected, according to patients＇ medication, omeprazole, ornidazole, fluconazole, moxifloxacin, linezolid were chosen as target drugs, drug concentration was determined by high performance liquid chromatography（HPLC）, in order to evaluate effect of CRRT on drug elimination. Results： From January 2012 to March 2015, 150 patients with an average age of（65±19） years were treated with CRRT, including 94 males and 56 females. Times of CRRT are between 1 and 28, involving multi-system diseases. The change of creatinine, alanine aminotransferase（ALT）, white blood cell and hemoglobin in patients undergoing CRRT demonstrated downward trend, and the change of Na＋, K＋, albumin were not obvious. Ultrafiltrate liquids were determined by HPLC, prototypes of omeprazole, ornidazole, linezolid were less and ultrafiltrate rates of these drugs were low; meanwhile, rates of fluconazole and moxifloxacin in all patients were high（about 50%）. Conclusion： Liver and kidney function and inflammatory status of critically ill patients receiving the treatment of CRRT were improved. Drug concentration of the ultrafiltrate liquid suggest that CRRT may increase fluconazole and moxifloxacin drug clearance, it is necessary to adjust the dose of the drug; while the effect of CRRT on omeprazole, ornidazole, linezolidis was less.

关 键 词：CRRT 奥美拉唑 奥硝唑 氟康唑 莫西沙星 利奈唑胺 

分 类 号：R459.5[医药卫生—治疗学] R9[医药卫生—临床医学]