不同剂量CRRT对脓毒症患者利奈唑胺体内清除的影响  

Effects of different doses of continuous renal replacement therapy on elimination of linezolid in patients with sepsis

作　　者：屠越兴[1] 韩芳[1] 吴爱萍[1] 倪银[1] 

机构地区：[1]浙江省人民医院重症医学科,杭州310014

出　　处：《浙江医学》2017年第22期1988-1990,共3页Zhejiang Medical Journal

基　　金：浙江省卫生厅骨干人才项目(2015RCB003);浙江省卫生厅一般研究项目(2014KYB029)

摘　　要：目的观察不同剂量连续肾脏替代治疗(CRRT)对脓毒症患者利奈唑胺体内清除的影响。方法将40例脓毒症患者随机分为标准剂量组和高容量血液滤过(HVHF)组,每组20例,分别给予不同剂量的CRRT,使用利奈唑胺的第7次开始,分别于0、1、2、4、6、8、12、18、24h时采集外周静脉血标本及滤出液标本,测定标本中利奈唑胺浓度并得出相关药代动力学参数进行比较。结果两组血中利奈唑胺浓度从2h开始差异明显,滤出液从4h开始差异明显。当MIC为1时,标准剂量组AUC0-24/MIC已明显高于HVHF组(P<0.05),但T>MIC两组差异无统计学意义(P>0.05);当MIC为2时标准剂量组的AUC0-24/MIC和T>MIC均明显高于HVHF组(P<0.05);当MIC为4时两组的AUC0-24/MIC和T>MIC水平均低,但标准剂量组还是明显高于HVHF组(P<0.05)。结论 CRRT剂量越大对利奈唑胺的清除越多,随着MIC值的增高,常规方法使用药物可能达不到满意的疗效,为了确保最佳的抗菌活性和临床疗效建议监测药物浓度。Objective To evaluate the effects of different doses of continuous renal replacement therapy（CRRT） on elimination of linezolid in patients with sepsis. Methods Forty patients with sepsis were randomly divided into two groups： standard dose group and high-volume hemofiltration（HVHF） group with 20 cases in each group. CRRT was performed from the seventh cycle of linezolid administration. Peripheral venous blood samples and filtrate samples were collected at 0, 1, 2, 4, 6, 8, 12, 18 and 24 h to determinate linezolid concentration and draw the relevant pharmacokinetic parameters. Results There was significant difference in the serum concentration of linezolid between the two groups from 2 h, and in the filtrate from 4 h. When MIC was 1, AUC0-24/MIC in the standard dose group was significantly higher than that in HVHF group（P0.05）. However, the difference in TMIC between the two groups was no signification（P 0.05）. When MIC was 2, the AUC0-24/MIC and TMIC in the standard group were significantly higher than those in the HVHF group（P0.05）. When MIC was 4, the levels of AUC0-24/MIC and T MIC in the two groups were low, but the standard dose group was significantly higher than the HVHF group（P0.05）. Conclusion The higher dose of CRRT would lead to more clearance of linezolid. With the increase of MIC value,the conventional use of drugs may not achieve satisfactory blood concentration. In order to ensure the best antibacterial activity and clinical efficacy, the drug concentration should be monitored.

关 键 词：连续肾脏替代治疗 利奈唑胺 脓毒症 

分 类 号：R459.7[医药卫生—急诊医学]