基于危重症患者病理生理特点的合理用药探讨  

Discussion of rational drug use based on the pathophysiological characteristics of critically ill patients

作　　者：杜洁 王玲[1,2] 龚志成 张丽娜[3] Du Jie;Wang Ling;Gong Zhicheng;Zhang Lina(Department of Pharmacy,Xiangya Hospital,Central South University,Changsha 410008,China;Hunan Clinical Research Center for Clinical Pharmacy,Xiangya Hospital,Central South University,Changsha 410008,China;Department of Critical Care Medicine,Xiangya Hospital,Central South University,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院药学部,长沙410008 [2]湖南省临床药学研究中心,长沙410008 [3]中南大学湘雅医院重症医学科,长沙410008

出　　处：《中华重症医学电子杂志》2024年第1期6-15,共10页Chinese Journal Of Critical Care & Intensive Care Medicine(Electronic Edition)

基　　金：宁夏回族自治区2021年重点研究资助项目(重大项目)(2021BEG01001)

摘　　要：重症患者病情危急且复杂多变,合并疾病较多或伴有器官功能异常,特殊治疗及侵入性操作的实施等因素均会使重症患者的药物代谢动力学发生变化,导致药物效应受到影响,不良反应发生风险相对增加。目前的说明书及相关文书的药物治疗大多是基于普通患者的研究结果及治疗推荐,因而难以保证重症患者的疗效及用药安全性。如何合理用药,保障用药安全已成为目前ICU医师和临床药师共同面临的重要课题。鉴于此,本文基于危重症患者的药物代谢特点,分析了其在特殊病理生理条件下、体外支持治疗条件下及特殊给药途径时存在的用药问题;并结合重症相关药物治疗的最新临床证据,提出临床合理用药策略。The condition of critically ill patients is inherently intricate and precarious,often compounded by the presence of complex ailments,organ dysfunction,or specialized invasive procedures.These factors significantly alter patients'pharmacokinetics,leading reduced drug efficacy and an escalated risk of adverse reactions.Currently,drug treatment protocols outlined in manuals and related documents is primarily derive from research conducted on typical patients,posing challenges in ensuring both efficacy and safety for critically ill individuals.Addressing the rational use of drugs and ensuring their safety has emerged as a pivotal concern for clinicians and clinical pharmacists in critical care.Based on the characteristics of drug metabolism in critically ill patients,we delved into the distinctive characteristics of drug metabolism in critically ill patients.It scrutinizes challenges pertaining to drug use amidst specific pathophysiological conditions,in vitro supportive treatment settings,and specialized drug delivery routes.By amalgamating the latest clinical evidence regarding severe drug treatments,this analysis proposes pragmatic strategies for rational drug administration.

关 键 词：危重症患者 药物代谢动力学 药物效应动力学 合理用药策略 

分 类 号：R969.3[医药卫生—药理学]