接受连续肾脏替代治疗的危重患者中抗菌药物的剂量选择

Antibacterial dose recommendations for critically ill patients receiving continuous renal replacement therapy

在接受连续肾脏替代治疗(CRRT)的危重患者中,抗菌药物剂量的选择是个复杂的问题,剂量选择不合理会产生药物的毒性作用或直接导致治疗失败和细菌耐药。一般而言,表观分布容积决定初始剂量,总清除率决定维持剂量。药物表观分布容积在急性肾损伤或危重患者中可发生变化。CRRT患者对药物的清除率取决于其模式、剂量以及滤过膜的筛分系数或饱和系数,二者数值主要取决于药物的蛋白结合率。本文综述了接受CRRT危重患者使用抗菌药物的药动学和药效学特点和影响因素,并提出CRRT患者使用抗菌药物的剂量建议,为临床合理用药提供参考。

Antibacterial doses for critically ill patients receiving continuous renal replacement therapy（CRRT） are complicated,and failure to correctly choose a dose may result in either drug toxicity or treatment failure,and development of antibiotic resistance.In general,the initial dose depends on the volume of distribution,and maintenance doses depend on clearance.The volume of distribution of some antibacterials is altered by critical illness or acute kidney injure,or both.Clearance of drugs in CRRT depends on the dose and mode of CRRT,and the sieving or saturation coefficient of the drug.Both sieving and saturation coefficient relate to the plasma protein binding.