重症感染患者病情严重程度对抗菌药物表观分布容积的影响

The analysis of the influence of severe infection on the apparent volume of distribution of antibacterial drugs

重症感染是威胁重症患者生命的常见病,早期合理使用抗菌药物是重症感染治疗的关键环节.重症患者特殊的病理生理状态影响抗菌药物药代动力学(PK),其中以表观分布容积(Vd)变化显著,这使药效学的达标率显著降低.多种因素可影响抗菌药物在重症患者体内的分布,如病情严重程度、器官功能障碍、组织水肿以及药物的亲水性等,且这些因素常常可能会同时存在.本文就重症患者病情严重程度对抗菌药物Vd的影响作一综述.

Sepsis is a major cause of mortality in intensive care unit (ICU). Early and correct antibacterial coverage is essential. But the pharmacokinetics (PK) of antibiotics can be compromised as a result of altered physiology in the critically ill patients. The apparent volume of distribution (Vd) is an important PK parameter and can determine the loading dose. This review article summarizes the key changes in Vd of antibiotic in patients with severe infection, and provides general suggestions on optimization of antibiotic dosing to deal with Vd challenges.