肾功能亢进患者抗菌药物合理应用现状  

Current situation of rational use of antibiotics in patients with augmented renal clearance

作　　者：崔红燕 周鹭 孙闻续[1] 吴逢波[1] CUI Hongyan;ZHOU Lu;SUN Wenxu;WU Fengbo(Dept.of Clinical Pharmacy,West China Hospital of Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院临床药学部,成都610041

出　　处：《中国药房》2022年第14期1782-1786,共5页China Pharmacy

基　　金：四川省科技计划项目(No.2019YFS0298)。

摘　　要：肾功能亢进是指患者的肾功能显著增强,表现为肾小球滤过率显著增加,使得药物清除增加,在常规剂量下无法达到有效的血药浓度。抗菌药物的抗菌疗效与浓度具有密切的关系。肾功能紊乱对药物代谢的影响是临床医师确定给药剂量时需考虑的重要因素。本文从肾功能亢进的定义、危险因素、发生机制、评估方法,以及其对抗菌药物药动学/药效学、给药方法的影响等方面进行综述,发现肾功能亢进广泛存在于危重症患者中,发生的危险因素包括年龄(≤50岁)、脑创伤、脓毒症、多发性创伤等。肾功能亢进患者使用抗菌药物时可通过增加给药剂量、延长给药时间、增加给药频次等途径来提高药物的治疗效果;但为了防止因药物高浓度蓄积而引起的不良反应发生,因此建议尽量联合治疗药物监测。Augmented renal clearance(ARC)refers to the significant enhancement of patients’renal function,which is manifested by the significant increase of glomerular filtration rate,which increases the clearance of drugs,and the effective blood drug concentration cannot be achieved under the conventional dose.The efficacy of antibiotics is closely related to the concentration.The influence of renal dysfunction on drug metabolism is an important factor that clinicians should consider when determining the dosage.This article reviews the definition,risk factors,occurrence mechanism,evaluation methods of ARC,as well as its impact on the pharmacokinetics/pharmacodynamics of antibiotics and administration methods.It is found that ARC widely exists in critically ill patients,and the risk factors include age(≤50 years old),brain trauma,sepsis,multiple trauma,etc.When using antibiotics in ARC patients,the therapeutic effect of drugs can be improved by increasing the dosage,prolonging the duration of administration and increasing the frequency of administration.However,in order to prevent adverse reactions caused by high concentration accumulation of drugs,it is recommended to try to combine treatment drug monitoring.

关 键 词：肾功能亢进 抗菌药物 药动学 药效学 剂量调整 抗菌疗效 肾小球滤过率 

分 类 号：R969.1[医药卫生—药理学] R978.1[医药卫生—药学]