应用阿米卡星时不同剂量溶媒对老年患者血药浓度及肾功能的影响

Effects of solvent with different doses on blood drug level and renal function in elderly patients receiving amikacin

目的比较应用阿米卡星时不同剂量溶媒对老年患者血药浓度及肾功能的影响。方法纳入需要使用阿米卡星抗感染的140例老年患者。其中A组、B组各40例,分别使用生理盐水100 mL+阿米卡星0.4 g、生理盐水250 mL+阿米卡星0.4 g;C组、D组各30例,分别使用生理盐水150 mL+阿米卡星0.6 g、生理盐水250 mL+阿米卡星0.6 g治疗。于治疗第3天用药后0.5 h、第4天用药前0.5 h分别检测阿米卡星血药峰浓度和谷浓度。于治疗前、治疗第4天用药前0.5 h检测血清肌酐、胱抑素C水平,比较肾功能损害发生率。结果A组、C组治疗前后的血清肌酐水平差异均无统计学意义(均P>0.05);治疗后,4组的胱抑素C水平、B组和D组的血清肌酐水平均较治疗前升高,且B组、D组的胱抑素C水平分别高于A组、C组(均P<0.05)。A组与B组之间、C组与D组之间的阿米卡星血药峰浓度和谷浓度、肾功能损害发生率差异均无统计学意义(均P>0.05)。结论老年患者应用阿米卡星时,扩大溶媒剂量稀释用药并不能减轻肾功能损害,治疗期间应监测血清胱抑素C水平以早期发现肾功能损害。

Objective To compare the effects of solvent with different doses on blood drug level and renal function in elderly patients receiving amikacin.Methods Totally 140 elderly patients requiring anti-infection with amikacin were enrolled.Among them,40 cases in group A and 40 cases in group B were treated with 100 mL normal saline+0.4 g amikacin and 250 mL normal saline+0.4 g amikacin,respectively;30 cases in group C and 30 cases in group D were treated with 150 mL normal saline+0.6 g amikacin and 250 mL normal saline+0.6 g amikacin,respectively.Peak and minimum blood drug levels of amikacin were measured after 30 minutes of administration on the third day of treatment and before 30 minutes of administration on the fourth day of treatment,respectively.Before treatment and before 30 minutes of administration on the fourth day of treatment,serum creatinine and cystatin C levels were determined for comparing the incidence rate of renal injury.Results In group A or group C,there was no statistically significant difference between serum creatinine levels before and after treatment(all P>0.05);after treatment,the cystatin C levels of the four groups and the serum creatinine levels of groups B and D were increased as compared with the pre-treatment levels,and group B and group D possessed a higher cystatin C level than group A and group C,respectively(all P<0.05).No statistically significant differences were found in peak or minimum blood drug level of amikacin,or incidence rate of renal injury between group A and group B,or between group C and group D(all P>0.05).Conclusion When application of amikacin to elderly patients,increasing the dose of the solvent for antibiotic dilution can not alleviate damage to renal function;besides,it is suggested that serum cystatin C level should be monitored during treatment so as to identify renal injury earlier.