碳青霉烯类治疗药物浓度监测在危重症患者中的应用进展

Progress of the application of therapeutic drug monitoring of carbapenem in patients with critical illness

治疗药物监测(TDM)以药代动力学(PK)为基础,研究药物在体内的过程,是临床个体化用药的重要手段,以得到最优药效动力学(PD)结果。危重患者由于特殊的病理生理状态,治疗过程中药物浓度自身及个体间差异明显,治疗剂量不足或药物毒性的风险增加。碳青霉烯类抗菌药物广泛应用于危重症患者抗感染治疗,结合PK/PD参数,采用TDM指导临床治疗十分必要,但目前临床实施仍不规范,有效性存在争议。本文就碳青霉烯类抗菌药物TDM在危重症患者中的应用进展作一综述。

Therapeutic drug monitoring(TDM) studies the process of drugs in vivo based on pharmacokinetics(PK). It is an important means of clinical individualized drug use to achieve optimal pharmacodynamics(PD). Due to the special pathophysiological state of patients with critical illness, there are obvious differences in drug concentration between themselves and individuals during treatment, which increases the risk of insufficient treatment dose or drug toxicity.Carbapenem antimicrobial agents are widely used in anti infection treatment of patients with critical illness. Combined with PK/PD parameters, it is necessary to use TDM to guide clinical treatment, but the clinical implementation is still not standardized at present, and the effectiveness is controversial. This paper reviews the application progress of carbapenem antimicrobial agents TDM in patients with critical illness.