临床药师参与肾脏替代治疗患者替考拉宁个体化药物治疗分析  

Analysis of Clinical Pharmacists Involving in the Individualized Medication of Teicoplanin in Patients with Renal Replacement Therapy

作　　者：薛宏志 石璐 唐莲[1] 陈芳[1] 陆件[2] 庄智伟[2] 袁云龙 虞燕霞[1] 周琴[1] 薛苏冬[1] Xue Hongzhi;Shi Lu;Tang Lian;Chen Fang;Lu Jian;Zhuang Zhiwei;Yuan Yunlong;Yu Yanxia;Zhou Qin;Xue Sudong(Department of Pharmacy,The Affiliated Suzhou Hospital of Nanjing Medical University,Suzhou 215002,Jiangsu,China;Intensive Care Unit,The Affiliated Suzhou Hospital of Nanjing Medical University,Suzhou 215002,Jiangsu,China;Medical Laboratory,The Affiliated Suzhou Hospital of Nanjing Medical University,Suzhou 215002,Jiangsu,China)

机构地区：[1]南京医科大学附属苏州医院药学部,江苏苏州215002 [2]南京医科大学附属苏州医院重症医学科,江苏苏州215002 [3]南京医科大学附属苏州医院医学检验科,江苏苏州215002

出　　处：《药物流行病学杂志》2021年第2期116-120,共5页Chinese Journal of Pharmacoepidemiology

基　　金：江苏省药学会天晴医院药学基金项目(编号:Q2019071);苏州市科技局-苏州市药学会医院药学科研项目(编号:SYSD2019186)。

摘　　要：为探讨替考拉宁在肾衰竭患者连续肾脏替代治疗(CRRT)下的清除情况,优化替考拉宁首剂负荷剂量和维持剂量,临床药师通过2例CRRT患者替考拉宁治疗药物监测(TDM)协助医师制定和优化替考拉宁的给药剂量。同时测定替考拉宁在CRRT上机时和下机时的血药浓度、滤出液浓度和尿液浓度,计算该药物的滤过系数和清除比率,为不同CRRT方式提供用药剂量参考。经个体化用药调整后血培养转阴,评估患者抗感染疗效好,未出现药物相关不良反应。因此对于重症感染推荐CRRT患者采用替考拉宁高负荷剂量,建议结合TDM结果、CRRT模式及治疗剂量、残余肾功能进行维持剂量调整。To explore the clearance of teicoplanin of renal replacement therapy(RRT) in patients with renal failure and optimize the first loading dose and maintenance dose of TDM,clinical pharmacists assisted physicians in designing and optimizing the dose of teicoplanin based on therapeutic drug monitoring(TDM) in two RRT patients. The blood concentrations,filtrate concentrations and urine concentrations of teicoplanin were measured at the time of during and after the RRT,and the filtration coefficient and clearance ratio of the drug were calculated to provide dose reference for different RRT modes. Blood cultures turned negative after individualized dosage adjustment,and the clinical efficacy was evaluated good,without drug-related toxic and side effects. For patients with severe infection,high loading dose of teicoplanin is recommended for CRRT patients with severe infection,and maintenance dose adjustment is suggested in combination with TDM results,CRRT mode,therapeutic dose and residual renal function.

关 键 词：临床药师 连续肾脏替代治疗 替考拉宁 治疗药物监测 

分 类 号：R97[医药卫生—药品]