危重患儿肾脏清除率增加的临床研究进展  

Advances in augmented renal clearance in critically ill children

作　　者：王浩楠 缪红军[1] Wang Haonan;Miao Hongjun(Department of Pediatric Intensive Care Unit(PICU)and Emergency Medicine,Children's Hospital of Nanjing Medical University,Nanjing210008,China)

机构地区：[1]南京医科大学附属儿童医院急诊/重症医学科,210008

出　　处：《国际儿科学杂志》2024年第11期744-748,共5页International Journal of Pediatrics

基　　金：南京市卫生健康委员会卫生科技发展专项资金项目(YKK23164)。

摘　　要：肾脏清除率增加(augmented renal clearance,ARC)是危重患儿中的常见现象,可显著影响经肾代谢药物的分布与代谢,进而造成治疗失败甚至选择性耐药等风险并导致不良结局,因此近年来受到广泛关注。ARC的发病原因尚无定论,通常认为与液体复苏、血管活性药使用等因素所介导的肾脏灌注上调有关。目前,虽然已有一定数量的国内外研究聚焦于ARC现象的预测及药学干预,但儿童ARC研究仍面临诸多挑战,如病例数量有限、诊断标准不统一以及患者异质性显著等。PICU医师应了解危重患儿ARC的临床评估的临床意义并积极监测与干预,以期帮助患儿在早期、足量的药物治疗中获益。Augmented renal clearance(ARC)is a common phenomenon in critically ill pediatric patients,which can significantly impact the distribution and metabolism of renally excreted drugs.This,in turn,may lead to treatment failure,selective resistance,and adverse outcomes,garnering considerable attention in recent years.The etiology of ARC remains inconclusive but is generally thought to be associated with increased renal perfusion mediated by factors such as fluid resuscitation and vasoactive drugs.Although many domestic and international studies have focused on the prediction and pharmaceutical intervention of ARC,research on pediatric ARC still faces numerous challenges,including limited cases,inconsistent diagnostic criteria,and significant patient heterogeneity.PICU physicians should be aware of the importance of assessing ARC in critically ill children,actively monitoring and intervening to ensure early and adequate drug therapy,thereby benefiting the patients.

关 键 词：感染 危重症 抗生素 肾脏清除率增加 药物清除 

分 类 号：R720.597[医药卫生—急诊医学]