重症患者头孢他啶阿维巴坦血药浓度与疗效的相关性及影响因素研究  

Correlation Between Ceftazidime-avibactam Blood Concentration and Efficacy in Critically Ill Patients and Influential Factors

作　　者：安姝润 廖利 潘欢妍 杨晓璇 张伟 成晓亮 葛卫红[3] 罗雪梅[3] 周玉皆[4] AN Shurun;LIAO Li;PAN Huanyan;YANG Xiaoxuan;ZHANG Wei;CHENG Xiaoliang;GE Weihong;LUO Xuemei;ZHOU Yujie(Department of Pharmacy,China Pharmaceutical University Nanjing Drum Tower Hospital,Nanjing 210008,China;Nanjing Qlife Medical Technology Co Ltd,Nanjing 210032,China;Department of Pharmacy,Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School,Nanjing 210008,China;Department of Respiratory and Critical Care Medicine,Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]中国药科大学南京鼓楼医院药学部,南京210008 [2]南京品生医疗科技有限公司,南京210032 [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呼吸与危重症医学科,南京210008

出　　处：《医药导报》2024年第8期1291-1295,共5页Herald of Medicine

摘　　要：目的评估重症患者头孢他啶阿维巴坦(CAZ-AVI)血药浓度与疗效的相关性及影响因素。方法测定29例重症患者CAZ-AVI给药48 h后头孢他啶与阿维巴坦的谷浓度(C_(min)),收集患者临床信息,并对血药浓度、疗效和影响因素进行相关性分析。结果治疗有效组头孢他啶和阿维巴坦的C_(min)分别为(50.95±5.17)和(7.52±0.96)mg·L^(-1),无效组头孢他啶和阿维巴坦的C_(min)分别为(31.16±7.03)和(5.37±1.32)mg·L^(-1)。有效组头孢他啶的C min显著高于无效组(P<0.05),而两组阿维巴坦的C min差异无统计学意义(P>0.05),Spearman相关分析显示,头孢他啶的C min与临床疗效呈正相关(P<0.05),阿维巴坦的C min与临床疗效无相关性(P>0.05),ROC曲线显示临床有效头孢他啶的C_(min)最佳阈值为24.59 mg·L^(-1)。多元线性回归分析显示,肌酐清除率、年龄与头孢他啶的C_(min)显著相关,肌酐清除率与阿维巴坦的C_(min)显著相关(P<0.05)。结论头孢他啶的浓度与疗效相关,在给药间隔内保持CAZ-AVI的浓度始终大于最低抑菌浓度可能更有利于减少耐药的发生和复发。同时,在优化给药方案时应考虑年龄、肌酐清除率对药物浓度的影响。Objective To evaluate the relationship between ceftazidime-avibactam(CAZ-AVI)blood concentrations and efficacy in critically ill patients and to investigate the factors influencing blood levels.Methods The CAZ-AVI trough concentrations(C_(min))were detected in 29 patients who received CAZ-AVI treatment for at least 48 hours.The clinical materials of the patients were collected together for retrospective analysis.Results The C_(min) of ceftazidime(CAZ)and avibactam(AVI)were(50.95±5.17)and(7.52±0.96)mg·L^(-1) in the effective group and(31.16±7.03)and(5.37±1.32)mg·L^(-1) in the ineffective group,respectively.The C_(min) of CAZ in the effective group was significantly higher than in the ineffective group(P<0.05),and there was no significant difference in AVI C_(min) between the two groups(P>0.05).Spearman’s correlation analysis showed that CAZ C_(min) was positively correlated with clinical efficacy(P<0.05),and no correlation between AVI C_(min) and clinical efficacy(P>0.05).The optimal CAZ C_(min) threshold was 24.59 mg·L^(-1).Multiple linear regression analysis showed that age and creatinine clearance was significantly correlated with the C_(min) of CAZ,and creatinine clearance was significantly correlated with AVI C_(min)(P<0.05).Conclusions The C_(min) of CAZ correlates with efficacy,and it may be more beneficial for clinical treatment to keep the concentration of CAZ-AVI always greater than the minimum inhibitory concentration during the dosing interval.The creatinine clearance should be fully considered when optimizing CAZ-AVI dosage in critically ill patients.

关 键 词：头孢他啶阿维巴坦 重症患者 血药浓度 疗效 影响因素 

分 类 号：R978[医药卫生—药品]