TDM指导特重度烧伤脓毒症患者多黏菌素B的个体化治疗一例  

TDM guided the individualized treatment of polymyxin B in a patient with severe burn sepsis

作　　者：刘霞[1,2] 赵双平 Liu Xia;Zhao Shuangping(Department of Critical Care Medicine,Xiangya Hospital,Central South University,Changsha 410008,China;Department of Critical Care Medicine,Taojiang County People's Hospital,Taojiang 413400,China)

机构地区：[1]中南大学湘雅医院重症医学科,长沙410008 [2]湖南省益阳市桃江县人民医院重症医学科,湖南桃江413400

出　　处：《中华重症医学电子杂志》2024年第1期85-89,共5页Chinese Journal Of Critical Care & Intensive Care Medicine(Electronic Edition)

摘　　要：1例特重度烧伤患者,烧伤面积约85%(深Ⅱ~Ⅲ度),烧伤后创面急性大量渗出、持续19 d行连续性肾脏替代治疗(CRRT),继发创面、肺部、血流及消化道的泛耐药鲍曼不动杆菌感染,合并多器官功能衰竭,予以积极处理创面,仍有反复感染,多次启动以多黏菌素B为基础的联合治疗方案,并通过治疗药物监测(TDM)在治疗期间多次监测多黏菌素B的药物浓度,合理调整给药剂量,在患者行左小腿截肢术后,体质量发生变化,药物浓度较前偏高,后通过剂量调整,最终使患者感染得到有效控制。One patient with extremely severe burn,with an area of about 85%(deep second to third degree),received continuous renal replacement therapy(CRRT)for 19 days.This was prompted by a sudden and significant release of fluid from the burn wound,followed by an infection caused by pan-drug resistant Acinetobacter baumannii.The infection affected various parts of the body,including the wound,lungs,bloodstream,and digestive tract,leading to multiple organ failure.Despite active treatment of the wound,the patient experienced recurring infections and required multiple rounds of combined treatment involving polymyxin B.Through therapeutic drug monitoring(TDM),the drug concentration of polymyxin B was monitored many times throughout treatment,allowing for appropriate dosage adjustment.After the amputation of the left leg,there was a change in body mass and an increase in drug concentration.Finally,through the adjustment of the dosage,the patient's infection was well controled.

关 键 词：特重度烧伤 脓毒症 治疗药物监测 连续性肾脏替代治疗 多黏菌素B 

分 类 号：R459.7[医药卫生—急诊医学] R644[医药卫生—治疗学]