去甲万古霉素在SICU重症患者的药动学

Pharmacokinetics of Norvancomycin of SICU Patients

目的研究去甲万古霉素在肝肾功能正常的重症患者体内的药动学过程。方法 9名肝肾功正常的SICU重症患者单剂量给予去甲万古霉素0.4 g静脉滴注,用高效液相色谱法测定患者血浆和尿中去甲万古霉素的药物浓度,并用Winnonlin软件处理统计药动学数据。结果血药数据结果显示,药物的平均t1/2β为(4.79±2.61)h,t1/2α为(0.69±0.33)h,Vd为(0.41±0.44)L.kg-1,k10为(0.45±0.26)h-1,ρmax为(23.46±13.69)mg.L-1,CL/F为(88.66±69.04)mL.min-1;尿药数据显示t1/2β为(3.48±0.92)h,k为(0.21±0.06)h-1,12 h药物累积排泄率为(22.08±21.55)%。结论去甲万古霉素在SICU重症患者体内的药动学过程与文献报道的健康人群存在差异。对此类患者的用药应注意药物浓度的监测,适时调整给药方案,以保证用药安全有效。

OBJECTIVE To study pharmacokineties of norvancomycin in SICU severe patients without liver or renal dysfunction. METHODS 9 SICU severe patients were given a single dose of 0. 4 g iv norvancomycin. The plasma and urine concentrations were determined with HPLC, and PK parameters were analyzed by WINNONLIN. RESULTS The pharmacokinetic parameters in plasma were as followed：t1/2β（4.79±2.61） h, t1/2a（0.69±0.33） b,Vd（0.41 ±0.44） L . kg-1 ,k10（0.45 ±0.26 ） h-1 ,pmax（23. 46 ± 13.69） mg . L-1 ,and CL（88. 66 ±69.04） mL . min-1. The pharmacokinetic parameters in urine were as followed： t1/2β （3.48 ±0. 92） h, k（0. 21 ± 0. 06） h -1 , 12 h accumulation of excretion percentage was （22. 08 ±21.55） %. CONCLUSION The pharmacokinetic profiles in SICU severe patients were different from pharmacokinetic profiles of normal population reported by researches before. SICU severe patients should be administrated individually with TDM, and the treatment should be adjusted timely, to guarantee safety and validity.