重症耶氏肺孢子菌肺炎患者复方磺胺甲噁唑血药浓度监测的临床研究  

Concentration monitoring of compound sulfamethoxazole in patients with severe pneumocystis jasinii pneumonia

作　　者：潘欢妍 祁慧[4] 梁培[3,4] 安姝润 李俐[3] PAN Huan-yan;QI Hui;LIANG Pei;AN Shu-run;LI Li(Nanjing Drum Tower Hospital,China Pharmaceutical University,Nanjing 210009;School of Basic Medicine and Clinical Pharmacy,China Pharmaceutical University,Nanjing 210009;Department of Pharmacy,Nanjing Drum Tower Hospital,Nanjing University,Nanjing 210008;Department of Critical Care Medicine,Nanjing Drum Tower Hospital,Nanjing 210008)

机构地区：[1]中国药科大学南京鼓楼医院,南京210009 [2]中国药科大学基础医学与临床药学学院,南京210009 [3]南京大学医学院附属鼓楼医院药学部,南京210008 [4]南京大学医学院附属鼓楼医院重症医学科,南京210008

出　　处：《中南药学》2023年第6期1653-1658,共6页Central South Pharmacy

摘　　要：目的通过监测复方磺胺甲噁唑(SMX-TMP)治疗耶氏肺孢子菌肺炎(PCP)血药峰浓度(C_(max))水平,评价其临床效果及不良反应。方法回顾性分析2016年3月至2022年8月60例重症患者接受SMX-TMP治疗PCP的临床资料,记录患者磺胺甲噁唑(SMX)C_(max)水平,评估临床治疗结局,评价药物不良反应等。结果SMX初始平均C_(max)为118.98 mg·L^(-1),浓度范围分布广泛(IQR,97.84~172.80),初始给药剂量与SMX初始C_(max)成显著正相关(r^(2)=0.099,P=0.014);治疗过程中68.33%的患者SMX C_(max)可以达到预先设定的目标水平;患者的总体死亡率为51.66%,治疗过程中无法达到目标水平是PCP患者临床治疗失败率和28d全因死亡的危险因素(P<0.05);与SMX-TMP相关的不良反应发生率为35.00%,患者SMX C_(max)高于目标水平时肾功能损伤的发生率显著增加(P<0.05)。结论在PCP患者治疗期间监测SMX水平可以改善患者的临床结局,减少不良反应的发生。Objective To determine the clinical efficacy and adverse reactions of sulfamethoxazole and trimethoprim(SMX-TMP)in the treatment of pneumocystis carinii pneumonia(PCP)by monitoring the C_(max) of SMX-TMP.Methods This study retrospectively analyzed the clinical data of 60 critically ill patients who received SMX-TMP for PCP from March 2016 to August 2022.The C_(max) level of SMX was recorded,the clinical treatment outcome was assessed,and the adverse drug reactions were evaluated.Results The initial average C_(max) of SMX was 118.98 mg·L^(-1),and the concentration range was wide(IQR,97.84~172.80).The initial dose was positively correlated with the initial C_(max) of SMX(r^(2)=0.099,P=0.014).During the treatment,68.33%patients of SMX C_(max) reached the preset target level.The overall mortality rate of patients was 51.66%.Failure to reach the target level during the treatment was a risk factor for treatment failure and 28-day all-cause death in PCP patients(P<0.05).The incidence of adverse reactions associated with SMX-TMP was 35.00%,and the incidence of renal dysfunction was significantly increased when SMX C_(max) was higher than the target level(P<0.05).Conclusion Monitoring SMX C_(max) levels during the treatment of PCP patients helps improve the clinical outcome of patients and reduce the incidence of adverse reactions.

关 键 词：耶氏肺孢子菌肺炎 复方磺胺甲噁唑 治疗药物监测 重症患者 

分 类 号：R969.3[医药卫生—药理学]