重症患者亚胺培南血药浓度监测结果的相关因素分析

Analysis of Related Factors of Imipenem Plasma Concentration Monitoring Results in Critically Illed Patients

收集109例重症患者基本临床资料与亚胺培南血药浓度,统计分析患者年龄、性别、剂量、连续性肾脏替代治疗(CRRT)、序贯性器官衰竭(SOFA)评分、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分,以及肝肾功能情况对血药浓度和药动学/药效学(PK/PD)达标情况的影响。其中67例患者测定了谷浓度,平均浓度为(3.52±2.59)μg·m L-1,42例测定了40%T浓度,平均浓度为(13.28±6.46)μg·m L-1,总体PK/PD达标率为61.5%。不同剂量组间达标率有差异(P<0.05);不同浓度组间肌酐清除率(CLcr)、血肌酐(Scr)、尿素(UREA)、估算肾小球滤过率(e GFR)和谷丙转氨酶(ALT)差异具有统计学意义(P<0.05)。提示肾功能情况对亚胺培南浓度影响较大,应根据患者总体情况制定个体化给药方案,以提高抗菌治疗的有效率。

The clinical data and imipenem concentrations of 109 critically illed patients were collected.The effects of age, sex, dose, continuous renal replacement therapy, SOFA score, APACHE Ⅱ score, liver and kidney function on imipenem concentrations and PK/PD target achievement were analyzed statistically.The average plasma concentration of 67 patients detected for trough concentration was（3.52±2.59） μg·m L-1.The average plasma concentration of 42 patients detected for 40%T concentration was（13.28±6.46） μg·m L-1.A total of 61.5% patients reached the PK/PD target. There was a significant difference of PK/PD target achievement between the different dose groups（P〈0.05）. CLcr, Scr, UREA, e GFR and ALT were statistically significant between different concentration groups（P〈0.05）. The results suggested that renal function had a great influence on imipenem concentration. We should develop individualized administration program according to the overall situation of patients, so as to improve the effectiveness of antimicrobial therapy.