重症医学科重症感染患者美罗培南血药浓度达标情况及影响因素分析

Analysis of Clinical Characteristics and Influencing Factors of Meropenem Concentration in ICU Patients with Serious Infection

目的:分析重症医学科(ICU)重症感染患者美罗培南血药浓度达标情况及可能的影响因素,为优化ICU重症感染患者美罗培南的给药提供依据。方法:采用回顾性研究方法,收集某院ICU 2017年1月-2020年12月使用美罗培南并监测浓度的病例资料,统计美罗培南血药浓度(C_(min))分布情况,目标浓度达标情况,分析血药浓度影响因素。结果:123例血样C_(min)为(9.43±8.56)μg·ml^(-1),以C_(min) 8μg·ml^(-1)为目标,血药浓度达标率为50.61%;不同剂量、肌酐清除率及尿量患者的C_(min)及目标浓度达标率比较,差异有统计学意义(P<0.05)。多重线性回归分析表明,美罗培南日剂量和肌酐清除率是ICU患者美罗培南C_(min)的主要影响因素(P<0.05)。结论:ICU重症感染患者美罗培南血药浓度达标率较低,给药剂量、肌酐清除率对C_(min)有显著影响,有必要行药物浓度监测来优化ICU重症感染患者美罗培南的给药。

Objective:To analyze the compliance rate and possible influencing factors for serum concentration of meropenem in intensive care unit(ICU)patients,and to provide basis for optimizing the administration of meropenem in the patients.Methods:A retrospective analysis was performed in ICU patients who were treated with meropenem and monitored the concentration from January 2017 to December 2020.The blood concentration distribution of meropenem and the target concentration reaching the standard were counted,and the influencing factors of blood concentration were analyzed.Results:As for the 123 blood samples,the average C_(min) of meropenem was(9.43±8.56)μg·ml^(-1),and 50.61%(63/123)reached the target range with 8μg·ml^(-1) as the target;there were significant differences in C_(min) and target concentration compliance rate among different dose groups and patients with various creatinine clearance and urine volume(P<0.05);multiple linear regression analysis showed that dosage and creatinine clearance were the main influencing factors for meropenem C_(min) in ICU patients(P<0.05).Conclusion:The C_(min) compliance rate of meropenem blood concentration in ICU patients with serious infection is low.Administration dose and creatinine clearance have significant effects on C_(min),and it is necessary to conduct drug concentration monitoring to optimize the administration of meropenem in ICU patients with severe infection.