低温治疗对药物的药代动力学和药效学影响的系统性评价  

Effect of therapeutic hypothermia on pharmacokinetics and pharmacodynamics: A systematic review

作　　者：王欣蕊 于晓佳[1] WANG Xin-rui;YU Xiao-jia(Department qf Pharmaceutical Affairs,Bwijing Chao-Yang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院药事部,北京100020

出　　处：《中国临床药理学杂志》2021年第3期321-325,共5页The Chinese Journal of Clinical Pharmacology

摘　　要：目的系统评价低温治疗对人体药代动力学和药效学的影响。方法检索PubMed、EmBase和Cocrane Library从数据库建库至2020-03-17,有关低温治疗对于人体药代动力学及药效学的比较研究,限制语言为英语。将纳入文献中药代动力学及药效学参数用相对差异表示,进行系统性评价。结果共纳入27项研究。在低温治疗的过程中,药代动力学和药效学参数可能发生变化。其中,有50.0%的研究发现药物半衰期发生变化,70.3%的研究发现药物清除率降低。药物半衰期增长、清除率下降导致药物的蓄积,因此应降低给药剂量。23.0%的研究表明药物分布容积发生变化,分布容积增高会导致疗效不佳,分布容积降低时治疗指数低的药物可能产生毒性反应。药效学参数的改变与药物作用靶点、代谢途径均有关。结论在低温治疗时,使用治疗指数低、治疗窗较窄的药物,应同时进行治疗药物监测以保障用药安全和有效。Objective To systematically review the effect of hypothermia on pharmacokinetics and pharmacodynamics. Methods A literature search was conducted within the PubMed, EmBase and Cochrane databases from inception to March 17th 2020. Included studies were comparative studies on the effect of therapeutic hypothermia on pharmacokinetics and pharmacodynamics. The searches were limited to English language. The pharmacokinetic and pharmacodynamic parameters of the included studies are expressed as relative differences for systematic evaluation. Results Twenty-seven studies were included. The result of systematic review shows that during therapeutic hypothermia, pharmacokinetics and pharmacodynamics parameters alter. The half-life of the drug was found changed in 50% of the studies, and the clearance of the drug was found decreased in 70.3% of the studies. The increase in drug half-life and the decrease in clearance rate lead to the accumulation of drugs, so the dosage should be reduced. Twenty-three percent of studies show that the volume of distribution of the drug changes. Increased volume of distribution will result in poor efficacy. When the volume of distribution decreases, drugs with a low therapeutic index may produce toxic reactions. Changes in pharmacodynamics parameters are related to drug target location and metabolic pathways.Conclusion Therapeutic drugs should be monitored at the same time to ensure the safety and effectiveness of medication when using drugs with low therapeutic index and narrow therapeutic window during hypothermia treatment.

关 键 词：治疗性低温 药代动力学 药效学 分布容积 半衰期 清除率 

分 类 号：R97[医药卫生—药品]