脓毒症CVVHDF模式万古霉素的药动学研究

Sepsis CVVHDF Mode Vancomycin Pharmacokinetics and Safety Assessment

目的:研究脓毒症患者在连续性静脉-静脉血液透析(CVVHDF)模式下万古霉素的药动学特点,为脓毒症患者合理用药提供依据。方法:20例脓毒症患者随机分为两组,将在CVVHDF模式下进行肾脏替代治疗的10例患者纳入实验组,其余10例为对照组;所有患者单次给予万古霉素1 g,多点抽取血液标本检测血药浓度,得到万古霉素在患者体内的药动学参数。结果:脓毒症患者体内万古霉素药动学参数符合二室模型。实验组的t1/2α、t1/2β、CL、AUC0-∞等参数与对照组比较,差异有统计学意义(P<0.05)。给药后24 h,实验组的CCr较给药前显著升高(P<0.05),也明显高于对照组同期(P<0.05)。结论:万古霉素在脓毒症患者体内药动学参数符合二室模型,脓毒症患者使用CVVHDF模式治疗后万古霉素的药动学参数发生明显变化,分布与清除速率加快,生物利用度下降。在CVVHDF模型下,常规剂量使用万古霉素较为安全。

Objective： To research on patients with sepsis in CVVHDF mode pharmacokinetic characteristics of vancomycin,and provide basis for the rational use of drugs to patients with sepsis. Methods： Twenty patients with sepsis were randomly divided into two groups,the renal replacement therapy in CVVHDF mode of 10 patients were included in the team,the remaining 10 cases as control group. All patients with a single given vancomycin 1. 0g,multi-point draw blood specimens to test,the blood drug concentration,got the vancomycin in pharmacokinetic parameters of the patient＇s body.Results： Vancomycin in sepsis patients pharmacokinetic parameters in line with the second chamber model. Compared with the control group,the team drug distribution in the body more rapidly,the difference of the t1 /2α、t1 /2β、CL、AUC0-∞between the two groups was statistically significant（ P〈0. 05）. 24 h after administration,the creatinine clearance rate of the team was increased significantly than before（ P〈0. 05）,and was significantly higher than that of the control group（ P〈0. 05）.Conclusion： Vancomycin in sepsis patients show the pharmacokinetic parameters of secondary chamber model use CVVHDF mode to treat sepsis patients,the pharmacokinetic parameters of vancomycin has obvious changes,compared to the patients with renal replacement therapy,the distribution of vancomycin in the body speed and rate is accelerated. Conventional dose of vancomycin in CVVHDF mode is safe.