连续性肾脏替代治疗患者美罗培南血药浓度监测与疗效分析  

Therapeutic Drug Monitoring and Efficacy Analysis of Meropenem in Patients with Continuous Renal Replacement Therapy

作　　者：吴思佳 鲁广先 陈芳[1] 段露芬 陆件[2] 庄智伟[3] 石璐 许洪涛 吴超超 周琴[1] 唐莲[1] WU Sijia;LU Guangxian;CHEN Fang;DUAN Lufen;LU Jian;ZHUANG Zhiwei;SHI Lu;XU Hongtao;WU Chaochao;ZHOU Qin;TANG Lian(Department of Pharmacy,the Affiliated Suzhou Hospital of Nanjing Medical University,Suzhou Municipal Hospital,Suzhou 215002,China;Intensive Care Unit,the Affiliated Suzhou Hospital of Nanjing Medical University,Suzhou Municipal Hospital,Suzhou 215002,China;Emergency Care Unit,the Affiliated Suzhou Hospital of Nanjing Medical University,Suzhou Municipal Hospital,Suzhou 215002,China;Hangzhou Biozon Medical Co.,Ltd,Hangzhou 310012,China)

机构地区：[1]南京医科大学附属苏州医院苏州市立医院药剂科,苏州215002 [2]南京医科大学附属苏州医院苏州市立医院重症医学科,苏州215002 [3]南京医科大学附属苏州医院苏州市立医院急诊监护室,苏州215002 [4]杭州佰辰医学检验所有限公司,杭州310012

出　　处：《医药导报》2023年第7期1085-1089,共5页Herald of Medicine

基　　金：苏州市科技局项目(SYSD2019189);江苏省药学会医院药学科研项目(A201915,H202109);苏州市临床重点病种诊疗技术专项(LCZX202112)。

摘　　要：目的分析行连续性肾脏替代治疗(CRRT)患者和肾功能不全未行CRRT患者血美罗培南谷浓度水平和疗效,评估CRRT对美罗培南清除的影响。方法回顾性分析2019年1月—2021年6月在南京医科大学附属苏州医院苏州市立医院住院、使用美罗培南治疗并行血药浓度监测的肾功能不全患者病历资料,按是否行CRRT分为CRRT组和非CRRT组,比较两组美罗培南给药方案、血美罗培南谷浓度及临床疗效。结果共纳入肾功能不全患者74例,其中CRRT组21例,非CRRT组53例。CRRT组平均血美罗培南谷浓度高于非CRRT组(P<0.01)。美罗培南给药剂量1 g、q8h平均血美罗培南谷浓度CRRT组高于非CRRT组(P<0.05)。非CRRT组临床有效率高于CRRT组(P<0.05)。血美罗培南谷浓度>4MIC组患者革兰阴性菌清除率显著高于血药谷浓度<4MIC组(P<0.01)。线性回归分析显示,超滤率与血美罗培南谷浓度有一定相关性(r=-0.454,P<0.05)。结论肾功能不全患者行CRRT时血美罗培南谷浓度更高,对美罗培南清除较非CRRT少。CRRT超滤率与血美罗培南谷浓度有一定相关性。对于泛耐药病原菌,血美罗培南谷浓度>4MIC可获得更好的革兰阴性菌清除效果。Objective To evaluate therapeutic drug monitoring and efficacy of meropenem in patients with continuous renal replacement therapy(CRRT)and patients with renal insufficiency but without CRRT,and to evaluate the effect of CRRT on the clearance of meropenem.Methods Patients with renal insufficiency receiving meropenem treatment and therapeutic drug monitoring in the Affiliated Suzhou Hospital of Nanjing Medical University from January 2019 to June 2021 were collected retrospectively.They were divided into the CRRT group and the non-CRRT group.Dosage regimen,blood trough concentration,and clinical efficacy were compared between the two groups.Results A total of 74 patients were included and divided into the CRRT group(21 cases)and the non-CRRT group(53 cases).The blood trough concentration of CRRT group was higher than that of non-CRRT group(P<0.01).The blood trough concentration of the CRRT group in dose of 1 g,q8h was higher than that of the non-CRRT group(P<0.05).The rate of clinical efficacy in the non-CRRT group was higher than that in the CRRT group(P<0.05).The clearance rate of gram-negative bacteria in the group with blood trough concentration>4MIC was higher than that of another group with blood trough concentration<4MIC(P<0.01).The linear regression analysis results indicated a certain correlation between blood trough concentration and ultrafiltration rate(r=-0.454,P<0.05).Conclusion Patients with CRRT had higher blood trough concentration and less clearance of meropenem than patients with renal insufficiency but without CRRT.There was a certain correlation between blood trough concentration and ultrafiltration rate in CRRT patients.For patients with Multi-resistant pathogens,keep blood through concentration>4MIC can obtain better clearance of gram-negative bacteria.

关 键 词：美罗培南 肾功能不全 连续性肾脏替代治疗 治疗药物监测 最小抑菌浓度 超滤率 

分 类 号：R978.1[医药卫生—药品] R969[医药卫生—药学]