连续性静脉-静脉血液滤过患者血清中利奈唑胺的浓度监测

Determination of serum linezolid concentration in critically ill patients during continuous veno-venous hemofiltration

目的:对连续性静脉-静脉血液滤过(continuous venovenous hemofiltration,CVVH)治疗的危重患者进行利奈唑胺血药浓度监测,为临床个体化治疗提供依据。方法:建立高效液相色谱法(以左氧氟沙星为内标),测定患者血清中利奈唑胺谷浓度。结果:利奈唑胺在0.31～20.00μg.mL-1内线性关系良好(r=0.999 5),定量限为0.31μg.mL-1。5例危重患者在治疗期间监测23次的利奈唑胺谷浓度变化明显,变化范围为1.53～17.10μg.mL-1。有2例患者谷浓度变化较大(相差近5倍)。结论:高效液相色谱法简单、快速、准确、灵敏、重复性好,可用于临床利奈唑胺的血药浓度监测。进行连续性静脉-静脉血液滤过治疗的患者,应用利奈唑胺时血药浓度变化较大,需要通过治疗药物监测的方法制定个体化给药方案。

ORJECTIVE To monitor the serum linezolid trough concentration in critically ill patients with continuous veno- venous hemofiltration （CVVH）,in order to make individualized treatment regiment for these patients. METItODS A method was established for determining linezolid in human serum by HPLC （internal standard method）. RESULTS A good linearity was demonstrated between 0. 31 - 20. 00μg·mL^-1 （r = 0. 999 5）, the lowest limit of quantification of 0. 31 μg·mL^-1. The rela- tive recovery was 99. 12%. Linezolid serum concentrations changed significantly in the five patients during CVVH, with the trough concentration range of 1.53- 17. 10 μg·mL^-1. The linezolid trough concentration in two patients showed changing greatly （nearly 5-fold）. CONCLUSION The method is simple, rapid, accurate, sensitive, reproducible, and validated for determi- nation of serum linezolid in patients. Linezolid serum concentrations in critically ill patients during continuous venovenous hemo- filtration showed significant variability. Drug concentration should be monitored in those patients in order to make individual regiment of linezolid in clinical practice.