基于PK/PD理论优化1例脓毒性休克患者抗感染治疗方案的病例分析

A case report of anti-infection therapeutic schedule for a patient with septic shock based on the PK/PD theory

目的探讨亚胺培南/西司他丁钠持续输注给药方案用于脓毒性休克合并急性肾损伤患者的疗效及临床药师参与药物治疗方案的作用。方法临床药师参与1例脓毒性休克合并急性肾损伤且未行持续肾替代治疗患者的抗菌药物治疗,基于抗菌药物PK/PD特性及脓毒性休克患者的病理生理学改变对抗菌药物药动学(PK)/药效学(PD)参数的影响方面,分析亚胺培南/西司他丁钠持续输注给药及剂量调整对药物治疗有效性及安全性的影响。结果结合患者病理生理学状态,并且根据亚胺培南/西司他丁钠PK/PD特性和静脉输注方法的循证医学依据,调整亚胺培南/西司他丁钠给药剂量、给药间隔和静脉输注方法,可获得满意的治疗效果。结论临床药师依据抗菌药物PK/PD理论并结合脓毒性休克患者的病理生理学特点,参与药物治疗方案的制定及调整,可以提高药物治疗的疗效和安全性。

Objective To investigate the therapeutic effect of continuous infusion regimen of imipenemcilastatin sodium in a patient with septic shock combined with acute kidney injury and the role of clinical pharmacist on the drug therapy. Methods We analyzed the availability and safety of continuous infusion regimen of imipenemcilastatin sodium and dosage adjustment by the participation of clinical pharmacist in a case where a patient was with septic shock combined with acute kidney injury but without renal replacement therapy. The analysis was based on the effects of antibacterial PK/PD characteristics and the pathophysiological changes in septic shock to antibacterial PK/PD parameters. Results Combining the pathophysiological changes of patients with PK/PD characteristics and evidencebased method of intravenous infusion of imipenem-cilastatin sodium, we could achieve satisfactory results by adjusting the dose, drug interval and methods of intravenous infusion of imipenem-cilastatin sodium. Conclusion Clinical pharmacists can improve the efficacy and safety of drug treatment by anticipating the regimen and adjustment of drug on the basis of antibacterial PK/PD characteristics and pathophysiological changes in patients with septic shock.