重症患者6种常用抗菌药物的TDM靶值和PK/PD靶值达标情况分析  

Analysis of TDM Target and PK/PD Target Attaintment of 6 Commonly Used Antibiotics in Critically Ill Patients

作　　者：董育珠 杜倩 陶丽 韩鹃 陈晓敏 张雷 DONG Yu-zhu;DU Qian;TAO Li;HAN Juan;CHEN Xiao-min;ZHANG Lei(Department of Pharmacy,the Third Affiliated Hospital of Chongqing Medical University,Chongqing 401120,China;Department of Intensive Care Unit,the Third Affiliated Hospital of Chongqing Medical University,Chongqing 401120,China;Huada Gene Technology Co.Ltd.,Shenzhen 518000,China)

机构地区：[1]重庆医科大学附属第三医院药剂科,重庆401120 [2]重庆医科大学附属第三医院重症医学科,重庆401120 [3]深圳华大基因股份有限公司,深圳518000

出　　处：《中国合理用药探索》2022年第7期18-24,共7页Chinese Journal of Rational Drug Use

基　　金：重庆市技术创新与应用发展专项资助项目(cstc2019jscx-msxmX0195)。

摘　　要：目的:调查常用的6种抗菌药物在本院重症患者中的治疗药物监测(therapeutic drug monitoring,TDM)靶值和药动学/药效学(pharmacokinetic/pharmacodynamic,PK/PD)靶值达标情况,为重症患者抗感染治疗提供参考。方法:选取本院2021年3月~2022年3月期间入住重症监护病房并接受TDM的危重症患者。采用非房室模型计算患者PK/PD指数,对患者临床特征、病原学结果以及纳入的6种抗菌药物血药浓度分布范围、TDM靶值和PK/PD靶值达标情况进行分析。结果:共纳入重症患者26例,均接受万古霉素、利奈唑胺、哌拉西林/他唑巴坦、美罗培南、伏立康唑、氟康唑6种抗菌药物中的2~3种联合抗感染治疗,共计100份血浆样本及204个血药浓度-时间数据。患者群体谷浓度和PK/PD指数差异大,TDM靶值和PK/PD靶值总体不达标率分别高达45.28%和55.36%。结论:6种抗菌药物在重症患者中的TDM靶值和PK/PD靶值达标率均较低,普遍存在低暴露和过暴露情况。提示应在此类患者中开展TDM,以精准调整给药剂量。Objective:To investigate TDM(therapeutic drug monitoring)target and PK/PD(pharmacokinetic/pharmacodynamic)target value for six commonly used antibiotics in critically ill patients and to provide references for anti-infective treatment in these patients.Methods:Critically ill patients admitted to the intensive care unit and receiving TDM from March 2021 to March 2022 in our hospital were selected.The non-compartmental model was used to calculate the PK/PD index of patients.The clinical characteristics,isolated pathogenic microorganisms,concentration distribution range of the six antibiotics,as well as TDM target and PK/PD target attaintment were analyzed.Results:A total of 26 critically ill patients were included in this study.All patients received two or three of the six antibacterial drugs,including vancomycin,linezolid,piperacillin/tazobactam,meropenem,voriconazole and fl uconazole.A total of 100 plasma samples and 204 plasma concentration-time data were collected.The trough concentration and PK/PD index of patients vary greatly.Total probability rate of TDM target and PK/PD target attaintment for six antibiotics were as high as 45.28%and 55.36%,respectively.Conclusion:The TDM target value and PK/PD target attaintment compliance rate of six antibiotics in critically ill patients were low.Concentration low-exposure and overexposure are common in the six antibiotics.It is suggested that TDM should be carried out in these patients to accurately adjust the dose.

关 键 词：抗菌药物 重症患者 治疗药物监测靶值 药动学/药效学靶值 非房室模型 血药浓度 

分 类 号：R969.1[医药卫生—药理学]