重症患者哌拉西林他唑巴坦血药浓度达标情况及影响因素分析

Clinical characteristics and influencing factors of piperacillin tazobactam concentration in critically ill patients

目的:分析重症患者哌拉西林他唑巴坦药物浓度达标情况,探讨其影响因素,为合理使用哌拉西林他唑巴坦提供依据。方法:回顾性收集长沙市第三医院重症监护病房(ICU)2020年1月至2022年7月使用哌拉西林他唑巴坦并监测了哌拉西林药物浓度的患者。统计分析哌拉西林药物浓度分布情况及达标情况,采用多重线性回归方法分析其影响因素。结果:共收集191例患者,哌拉西林谷浓度(C_(min))为26.33[11.93,51.77]μg·mL^(–1),以C_(min)16~64μg·mL^(–1)为目标,C_(min)达标率为49.21%;单因素分析显示,年龄、体质量指数(BMI)、给药日剂量、输注时间、肌酐清除率(Ccr)、平均24 h尿量、白蛋白、谷丙转氨酶、谷草转氨酶、总胆红素是哌拉西林药物浓度的影响因素;多重线性回归分析表明,BMI、给药日剂量、输注时间、Ccr、谷丙转氨酶和总胆红素是哌拉西林血药浓度的影响因素。结论:重症患者哌拉西林血药浓度达标率较低,影响因素较多,有必要行治疗药物监测(therapeutical drug monitoring,TDM)以优化重症患者哌拉西林他唑巴坦的给药。

OBJECTIVE To explore the compliance of piperacillin tazobactam concentration,examine its influencing factors and provide rationales for rational use of piperacillin tazobactam in critically ill patients.METHODS A retrospective analysis was performed for 191 critically ill patients on a regimen of piperacillin tazobactam from January 2020 to July 2022.The distribution and compliance of piperacillin concentration were monitored.And multiple linear regression was performed for examining the influencing factors of piperacillin concentration.RESULTS The trough concentration(C_(min))was 26.33(11.93,51.77)μg·mL^(-1)and 49.21%of them reached the target range.Single factor analysis indicated that age,body mass index(BMI),daily dose,infusion time,creatinine clearance rate(Ccr),average 24 h urine volume,albumin,glutamic acid transaminase,glutamic oxalacetic transaminase and total bilirubin were the influencing factors of piperacillin concentration.Multiple linear regression analysis revealed that BMI,daily dose,infusion time,Ccr,alanine transaminase and bilirubin total bilirubin were the influencing factors.CONCLUSION C_(min)compliance rate of piperacillin is relatively low in critically ill patients and there are many influencing factors.It is imperative to optimize the dosing of piperacillin tazobactam through therapeutic drug monitoring(TDM).