延长的每日血液透析对万古霉素的清除作用

Removal of vancomycin in extended daily dialysis

目的:探讨延长的每日透析(extended daily dialysis,EDD)对患者外周血中万古霉素的清除作用。方法:选择在ICU住院的8例少尿急性肾衰竭并且接受EDD和万古霉素治疗的患者,EDD治疗时间为8 h,血流量180 ml/min,透析液流量150 ml/min。EDD治疗开始后采集0,2,4,8 h的血样测定万古霉素血药浓度变化情况。结果:8 h的EDD治疗,万古霉素血药浓度平均下降37.0%。最初的4 h EDD清除万古霉素速度(29.0±7.2)%比后4h(11.8±5.2)%快(P<0.05)。结论:EDD治疗的患者可能会出现抗感染治疗不足的情况,当EDD治疗前万古霉素血药浓度在20～30μg/ml时,透析结束后应该给予万古霉素补充剂量。同时,治疗性药物浓度监测仍然是目前万古霉素给药方案及调整的主要方法。

Objective： This study was designed to evaluate the extent of vancomycin removal from the blood compartment during extended daily dialysis（EDD）.Methods： Eight ICU patients were selected.They all had oliguric acute renal failure requiring EDD and were on vancomycin therapy.The blood flow rate and dialysate flow rate are fixed at 180 ml/min and 150 ml/min respectively.Blood samples were drawn at 0,2,4,and 8 hours to determine the extent of reduction in vancomycin level.Results： The total reduction of vancomycin was about 37% with an 8-hour treatment,when following a typical EDD prescription.Drug removal was greatest during the first 4 hours（29.0±7.2）% compared to the last 4 hours（11.8±5.2）% of EDD（P0.05）.Conclusion： EDD patients maybe at risk for undertreatment of their infections.A redosing strategy should be considered if the estimated or measured predialysis level is 20-30 μg/ml.Therapeutic drug monitoring is still an essential part of any dosing scheme.