Optimal indicator for changing the filter during the continuous renal replacement therapy in intensive care unit patients with acute kidney injury:A crossover randomized trial

BACKGROUND:The study aims to investigate an optimal indicator for changing the filter during the continuous renal replacement therapy(CRRT)in intensive care unit(ICU)patients with acute kidney injury(AKI).METHODS:Patients with AKI requiring CRRT in an ICU were randomly divided into two groups for crossover trial,i.e.,groups A and B.Patients in the group A were firstly treated with continuous veno-venous hemofiltration(CVVH),followed by continuous veno-venous hemodiafiltration(CVVHDF).Patients in the group B were firstly treated with CVVHDF followed by CVVH.Delivered doses of solutes with different molecular weights at the indicated time points between groups were compared.A correlation analysis between the delivered dose and pre-filter pressure(P_(PRE))and transmembrane pressure(P_(TM))was performed.Receiver operating characteristic(ROC)curves were constructed to evaluate the accuracy of P_(TM) as an indicator for filter replacement.RESULTS:A total of 50 cases were analyzed,27 in the group A and 23 in the group B.Delivered doses of different molecular-weight solutes significantly decreased before changing the filter in both modalities,compared with those at the initiation of treatment(all P<0.05).In the late stage of CRRT,the possible rebound of serum medium-molecular-weight solute concentration was observed.P_(TM) was negatively correlated with the delivered dose of medium-molecular-weight solute in both modalities.The threshold for predicting the rebound of serum concentration of medium-molecularweight solute by P_(TM) was 146.5 mm Hg(1 mm Hg=0.133 k Pa).CONCLUSIONS:The filter can be used as long as possible within the manufacturer’s safe use time limits to remove small-molecular-weight solutes.P_(TM) of 146.5 mm Hg may be an optimal indicator for changing the filter in CRRT therapies to remove medium-molecular-weight solutes.

High-Precision Vital Signs Detection Method Based on Spectrum Refinement and Extended DCMA

In this paper,the spectral estimation algorithm is extended to the detection of human vi-tal signs by mm-wave frequency modulated continuous wave(FMCW)radar,and a comprehensive algorithm based on spectrum refinement and the extended differentiate and cross multiply al-gorithm(DCMA)has been proposed.Firstly,the improved DFT algorithm is used to accurately obtain the distance window of human body.Secondly,phase ambiguity in phase extraction is avoided based on extended DCMA algorithm.Then,the spectrum range of refinement is determ-ined according to the peak position of the spectrum,and the respiratory and heartbeat frequency information is obtained by using chirp z-transform(CZT)algorithm to perform local spectrum re-finement.For verification,this paper has simulated the radar echo signal modulated by the simu-lated cardiopulmonary signal according to the proposed algorithm.By recovering the simulated car-diopulmonary signal,the high-precision respiratory and heartbeat frequency have been obtained.The results show that the proposed algorithm can effectively restore human breathing and heart-beat signals,and the relative error of frequency estimation is basically kept below 1.5%.

美国《保健物理》(Health Physics)杂志英文摘要(2023年125卷第4期)(英文)

Fetal and Maternal Atomic Bomb Survivor Dosimetry Using the J45 Pregnant Female Phantom Series:Considerations of the Kneeling and Lying Posture with Comparisons to the DS02 System Sean J.Domal1,Camilo M.Correa-Alfonso1,Colin J.Paulbeck2,Keith T.Griffin3,4,Tatsuhiko Sato5,Sachiyo Funamoto6,Harry M.Cullings6,Stephen D.Egbert7,Akira Endo8,Nolan E.Hertel4,Choonsik Lee3,Wesley E.Bolch9(1.Medical Physics Program,College of Medicine,University of Florida,Gainesville,FL;2.Department of Radiology,Johns Hopkins University,Baltimore,MD;3.National Cancer Institute,National Institutes of Health,Rockville,MD;4.George W.Woodruff School of Mechanical Eng.,Georgia Institute of Technology,Atlanta,GA;5.Nuclear Science and Engineering Center,Japan Atomic Energy Agency,Tokaimura,Japan;6.Department of Statistics,Radiation Effects Research Foundation,Hiroshima,Japan;7.Consultant,San Diego,CA;8.Nuclear Science Research Institute,Japan Atomic Energy Agency,Tokaimura,Japan;9.J.Crayton Pruitt Family Department of Biomedical Eng.,University of Florida,Gainesville,FL USA)Abstract:Organ dosimetry data of the atomic bomb survivors and the resulting cancer risk models derived from these data are currently assessed within the DS02 dosimetry system developed through the Joint US-Japan Dosimetry Working Group.In DS02,the anatomical survivor models are limited to three hermaphroditic stylized phantoms—an adult(55 kg),a child(19.8 kg),and an infant(9.7 kg)—that were originally designed for the preceding DS86 dosimetry system.As such,organ doses needed for assessment of in-utero cancer risks to the fetus have continued to rely upon the use of the uterine wall in the adult non-pregnant stylized phantom as the dose surrogate for all fetal organs regardless of gestational age.

低剂量持续输注瑞马唑仑对颌面外科术后患者首夜睡眠质量的影响

目的 探讨低剂量持续输注瑞马唑仑对颌面外科术后患者首夜睡眠质量的影响。方法 选取2021年8月9日至2013年8月9日中国医学科学院整形外科医院颌面外科手术患者80例。随机分为对照组和瑞马唑仑组,每组40例。对照组术后无镇静药物输注,瑞马唑仑组术后首夜低剂量持续输注瑞马唑仑[0.2 mg/(kg·h)]。比较两组术后首夜N1、N2、N3及快动眼(rapid eye movement, REM)期睡眠时间、清醒时间、觉醒次数、睡眠效率,术后首夜不良反应及镇静镇痛药物补救情况。结果 80例患者中,男16例,女64例,年龄18~40岁,平均(26.3±5.7)岁。瑞马唑仑组N1期睡眠时间及睡眠效率高于对照组[177.7(108.1,262.4)min比90.5(70.6,131.8)min、81.3%(54.7%,96.0%)比68.6%(53.4%,82.8%)]、REM期睡眠时间及觉醒次数低于对照组[2.3(0.0,11.1)min比47.1(1.6,91.1)min、6.5(2.0,12.0)次比26.0(18.3,43.3)次];瑞马唑仑组SpO2<90%及心动过速的比例高于对照组(70.0%比37.5%、95.0%比80.0%),差异均有统计学意义(P<0.05),两组其他不良反应及镇静镇痛药物补救情况的比较,差异均无统计学意义(P>0.05)。结论 低剂量持续输注瑞马唑仑可有效延长颌面外科患者术后N1期睡眠时间,缩短REM期睡眠时间,减少觉醒次数,提高睡眠效率,无严重不良反应。

大剂量连续性肾脏替代疗法对急诊脓毒症患者炎性因子水平及微循环的影响

目的探讨大剂量连续性肾脏替代疗法在急诊脓毒症患者治疗中的应用效果。方法62例急诊脓毒症患者随机分为两组。在常规治疗基础上,对照组采用常规剂量连续性肾脏替代疗法治疗,观察组采用大剂量连续性肾脏替代疗法治疗。比较两组的炎性因子水平、微循环指标。结果治疗48 h后,两组的IL-6、TNF-α水平均较治疗前降低,且观察组的IL-6、TNF-α水平均低于对照组(P<0.05)。治疗48 h后,两组的MFI、PPV均较治疗前升高,且观察组的MFI、PPV均高于对照组(P<0.05)。结论大剂量连续性肾脏替代疗法治疗急诊脓毒症患者可显著降低其炎性因子水平,改善其微循环。

In Frail Elderly Patients, Low-Dose Gemcitabine over 6-Hour Infusion Is Equally Effective and Less Toxic Than the Standard Gemcitabine Protocol for Advanced Pancreatic Adenocarcinoma: A Randomized Phase II Trial

Background:?Treatment of frail elderly patients with pancreatic cancer is still a major problem due to intolerance to standard chemotherapy doses. Aim:?This study aims to compare the low-dose gemcitabine over 6 hours (LD6H) to the standard gemcitabine protocol in terms of clinical benefit, survival, and safety in the frail elderly patients with advanced pancreatic adenocarcinoma. Methods:?Patients enrolled in this trial were randomly assigned by in a 1:1 fashion via closed envelope method to either receive gemcitabine of 1000 mg/m2?over 30-minute infusion on days 1, 8, and 15 of every 4-week cycle (standard protocol arm) or gemcitabine as a weekly low-dose (250 mg/m2) over 6-hour infusion (LD6H arm). Results:?We enrolled eighty-two eligible frail elderly patients with advanced pancreatic cancer. The patients were randomly assigned to receive either standard gemcitabine protocol (40 patients) or low-dose (250 mg/m2) gemcitabine over 6-hour infusion, given weekly (42 patients). There was no significant difference between the standard group and low-dose group as regard of the overall response rate (p = 0.654), the disease control rate (DCR) (p = 0.845), the median progression-free survival (PFS) (p = 0.908) and the overall survival (OS) (p = 0.331). The low-dose regimen had a significantly lower incidence of adverse effects grades 3 or 4 when compared to the standard regimen: (p = 0.024 for fatigue, p = 0.027 for hypotension, p = 0.012 for each anemia as well as thrombocytopenia, and p = 0.006 for neutropenia). Conclusion:?Low-dose gemcitabine over 6-hour infusion is equally effective and less toxic when compared to standard gemcitabine protocol in frail elderly patients with advanced pancreatic adenocarcinoma. So, we recommend the low-dose gemcitabine for frail elderly patients with advanced pancreatic cancer.

HYTRIN (continued)

Teratogenic effect: HYTRIN was not teratogenic in either rats or rabbits when administered at oral doses up to 1330 and 165 times,zespectively,the maximum recommended human dose.Fetal resoaptions occured in rats dcsed with 480 mg/kg/day,appzoximately 1330 times the maximum recommened human dose.Increased fetal resorptions,decreased fetal weight and an increased humber of supernumerary ribs were observed in offspring

Stepwise Method Based on Confidence Bound and Information Incorporation for Identifying the Maximum Tolerable Dose

The primary goal of a phase I clinical trial is to find the maximum tolerable dose of a treatment. In this paper, we propose a new stepwise method based on confidence bound and information incorporation to determine the maximum tolerable dose among given dose levels. On the one hand, in order to avoid severe even fatal toxicity to occur and reduce the experimental subjects, the new method is executed from the lowest dose level, and then goes on in a stepwise fashion. On the other hand, in order to improve the accuracy of the recommendation, the final recommendation of the maximum tolerable dose is accomplished through the information incorporation of an additional experimental cohort at the same dose level. Furthermore, empirical simulation results show that the new method has some real advantages in comparison with the modified continual reassessment method.

Basal or bolus dose, which is the key factor in CSII?

Objective: To observe the value of HbA1c level evaluating the total daily basal insulin dose by continuous subcuta- neous insulin infusion (CSII) in 268 patients with type 2 diabetes mellitus. Methods: 5-point capillary blood glucose was moni- tored in pre- and post-CSII and the insulin dose which could stabilize blood glucose was defined as the total daily dose of insulin, including basal and bolus total dose. Correlation between HbA1c level and total daily dose of insulin in patients with type 2 dia- betes mellitus was analyzed. Correlation between HbA1c level and 5-point capillary blood glucose was also analyzed. Results: Obvious correlation was observed between HbA1c level and the basal total daily dose of insulin if HbA1c was more than 9.3% (r=0.635, P<0.05). The average of 5-point capillary blood glucose was best correlated with HbA1c and fasting blood glucose next best. Conclusion: HbA1c level can forecast basal total daily dose of insulin in CSII.

大剂量呋塞米持续静脉泵入致急性心力衰竭患者急性肾损伤的风险因素分析及预测模型构建

目的:分析急性心力衰竭(AHF)患者应用大剂量呋塞米持续静脉泵入所致急性肾损伤(AKI)的风险因素及构建相应预测模型。方法:回顾性选取2020年1月~2022年5月期间本院急诊科收治的100例符合标准的AHF患者作为研究对象,根据治疗期间是否发生AKI分为合并AKI组(n=37)及未合并AKI组(n=63)。组间临床资料进行单因素及多因素Logistic回归分析,得出发生AKI的风险因素;根据相关系数构建预测模型,并选用受试者工作特征(ROC)曲线评估预测模型的效能。结果:单因素分析结果提示,年龄、高血压史、吸烟史、尿素氮、血清肌酐、红细胞计数、白蛋白、血红蛋白和N-末端脑钠肽前体(NT-proBNP)均是AHF患者应用大剂量呋塞米持续静脉泵入所致AKI发生的风险因素(P<0.05)。多因素Logistic回归分析结果提示,高龄(OR=1.115,95%CI=1.019~1.220,P=0.021)、高尿素氮水平(OR=1.384,95%CI=1.107~1.731,P<0.001)和高NT-proBNP(OR=1.005,95%CI=1.001~1.009,P=0.009)均是AHF患者应用大剂量呋塞米持续静脉泵入所致AKI发生的独立危险因素;高白蛋白水平(OR=0.550,95%CI=0.370~0.819,P<0.001)是AHF患者应用大剂量呋塞米持续静脉泵入所致AKI发生的独立保护因素。ROC曲线分析结果显示,预测模型的ROC曲线下面积为0.872(95%CI=0.805~0.939,P<0.001),最大约登指数为0.639,对应的灵敏度为0.937,特异度为0.703。结论:高龄、高尿素氮水平和高NT-proBNP水平均是AHF患者应用大剂量呋塞米持续静脉泵入所致AKI发生的独立危险因素,高白蛋白水平为独立保护因素。此外,根据上述风险因素构建的预测模型,其预测效能良好,对临床评估AKI风险具有一定的借鉴意义。

Decontamination of alachlor herbicide wastewater by a continuous dosing mode ultrasound/Fe^(2+)/H_2O_2 process

We used a ultrasound/Fe2＋/H2O2 process in continuous dosing mode to degrade the alachlor. Experimental results indicated that lower pH levels enhanced the degradation and mineralization of alachlor. The maximum alachlor degradation （initial alachlor concentration of 50 mg/L） was as high as 100% at pH 3 with ultrasound of 100 Watts, 20 mg/L of Fe2＋, 2 mg/min of H2O2 and 20℃ within 60 min reaction combined with 46.8% total organic carbon removal. Higher reaction temperatures inhibited the degradation of alachlor. Adequate dosages of Fe2＋ and H2O2 in ultrasound/Fe2＋/H2O2 process not only enhance the degradation efficiency of alachlor but also save the operational cost than the sole ultrasound or Fenton process. A continuous dosing mode ultrasound/Fe2＋/H2O2 process was proven as an effective method to degrade the alachlor.

大剂量维生素D联合胰岛素泵持续注射对妊娠期糖尿病患者血糖水平及妊娠结局的影响

目的探究大剂量维生素D联合胰岛素泵持续注射对妊娠期糖尿病患者血糖水平及妊娠结局的影响。方法选取2020年1月至2022年1月荣成市妇幼保健院接诊的102例妊娠期糖尿病患者进行随机对照试验。随机数字表法将其分为常规组和研究组,各51例。常规组年龄(35.25±5.26)岁;研究组年龄(36.25±6.54)岁。常规组小剂量维生素D联合胰岛素泵持续注射治疗。研究组大剂量维生素D联合胰岛素泵持续注射治疗。治疗2个月后,比较两组疗效、血糖水平[空腹血糖(FBG)、糖化血红蛋白(HbA1c)]、不良反应发生情况以及妊娠结局。采用χ^(2)检验和t检验。结果研究组总有效率高于常规组[92.16%(47/51)比74.51%(38/51),χ^(2)=5.718,P=0.017]。治疗前,两组HbA1c、FBG水平差异均无统计学意义(t=0.305、0.854,P=0.761、0.471)。治疗后,两组FBG、HbA1c水平均低于治疗前,且研究组FBG、HbA1c水平低于常规组(t=3.854、5.387,均P<0.001)。两组不良反应总发生率差异无统计学意义(χ^(2)=1.097,P=0.295)。随访至分娩,常规组新生儿窒息2例,早产儿5例,巨大儿2例;研究组早产儿1例,巨大儿1例;研究组术后不良妊娠结局发生率低于常规组[3.92%(2/51)比17.65%(9/51);χ^(2)=4.993,P=0.025]。结论大剂量维生素D联合胰岛素泵持续注射对妊娠期糖尿病患者效果显著,可降低血糖水平,改善妊娠结局,且安全。

Continuous Low-dose-rate Irradiation of Iodine-125 Seeds Inhibiting Perineural Invasion in Pancreatic Cancer

Background：Perineural invasion （PNI） is a histopathological characteristic of pancreatic cancer （PanCa）.The aim of this study was to observe the treatment effect of continuous low-dose-rate （CLDR） irradiation to PNI and assess the PNI-related pain relief caused by iodine-125 （125I） seed implantation.Methods：The in vitro PNI model established by co-culture with dorsal root ganglion （DRG） and cancer cells was interfered under 2 and 4 Gy of 125I seeds CLDR irradiation.The orthotopic models of PNI were established,and 125I seeds were implanted in tumor.The PNI-related molecules were analyzed.In 30 patients with panCa,the pain relief was assessed using a visual analog scale （VAS）.Pain intensity was measured before and 1 week,2 weeks,and 1,3,and 6 months after 125I seed implantation.Results：The co-culture of DRG and PanCa cells could promote the growth of PanCa cells and DRG neurites.In co-culture groups,the increased number of DRG neurites and pancreatic cells in radiation group was significantly less.In orthotopic models,the PNI-positive rate in radiation and control group was 3/11 and 7/11;meanwhile,the degrees of PNI between radiation and control groups was significant difference （P 〈 0.05）.At week 2,the mean VAS pain score in patients decreased by 50% and significantly improved than the score at baseline （P 〈 0.05）.The pain scores were lower in all patients,and the pain-relieving effect was retained about 3 months.Conclusions：The CLDR irradiation could inhibit PNI of PanCa with the value of further study.The CLDR irradiation could do great favor in preventing local recurrence and alleviating pain.

小剂量氢化可的松联合连续肾脏替代疗法治疗脓毒症的临床效果

目的观察小剂量氢化可的松联和连续肾脏替代疗法治疗脓毒症的临床效果。方法本研究选择前瞻性随机对照试验,选取2019年12月—2021年10月当阳市人民医院收治的脓毒症患者100例,采用计算机随机分组法分为试验组和对照组,每组50例。对照组患者单纯应用连续肾脏替代疗法治疗,试验组患者则在对照组的基础上加用小剂量氢化可的松治疗,2组治疗7 d。比较2组患者治疗前后炎性指标[降钙素原(PCT)、白介素-6(IL-6)]、免疫功能指标[人类白细胞抗原(HLA-DR)、CD64]变化及不良反应。结果治疗7 d后,2组患者PCT及IL-6水平均较治疗前降低,且试验组低于对照组(P均<0.01);2组患者HLA-DR较治疗前升高、CD64较治疗前降低,且试验组升高或下降幅度大于对照组(P均<0.01)。试验组与对照组不良反应总发生率比较差异无统计学意义(18.00%vs.16.00%,χ^(2)=0.332,P=0.564)。结论小剂量氢化可的松联合连续肾脏替代疗法治疗脓毒症可获得良好效果,可在改善患者各项生理指标的同时保障治疗安全性,不良反应较少,具有良好的应用价值,值得进一步推广。

不同持续性肾脏替代疗法(CRRT)治疗剂量对ICU感染性休克患者的影响

目的分析ICU感染性休克患者在就诊期间选择不同持续性肾脏替代疗法(continuous renal replace‐ment therapy,CRRT)治疗剂量的影响。方法选取2022年9月—2023年9月山东省莱西市人民医院收治的76例ICU感染性休克患者作为研究对象,根据随机数表法分为大剂量组和小剂量组,各38例,前一组行大剂量CRRT治疗,后一组行小剂量CRRT治疗,比较两组应激反应、炎症因子、免疫功能及转归情况。结果治疗后,大剂量组丙二醛、髓化过氧化物酶水平低于小剂量组,差异有统计学意义(P<0.05)。治疗后,大剂量组的CD4+、CD3+水平高于小剂量组,差异有统计学意义(P<0.05)。治疗前后两组CD8+水平比较,差异无统计学意义(P>0.05)。大剂量组多器官功能障碍综合征(multiple organ dysfunction syndrome,MODS)发生率为7.89%,7 d内死亡率为2.63%,均低于小剂量组,差异有统计学意义(χ^(2)=4.828、5.029,P<0.05)。大剂量组ICU治疗时间短于小剂量组,差异有统计学意义(P<0.05)。结论大剂量CRRT治疗效果更明显,能减少MODS事件发生,提高患者生存率,增强免疫功能,减轻炎症和应激反应,利于改善ICU感染性休克患者预后。

高低剂量醛红叶酸合并氟脲嘧啶治疗晚期胃肠道癌

本文观察了国产酸氢叶酸（ＣＦ）两种不同剂量（２０ｍｇ／Ｍ￣２和２００ｍｇ／Ｍ￣２）合并５－Ｆｕ静脉持续１２０小时滴注治疗晚期胃肠道癌５２例的疗效。认为采用低剂量国产ＣＦ合并５－Ｆｕ联合化疗方案在临床上更合适，安全经济，有一定推广价值。

投配率对连续两相厌氧发酵酸化效果的影响

采用自行设计的连续两相厌氧发酵小试装置,研究投配率对牛粪酸化效果的影响。探讨了投配率分别为50%、33%、20%和14%,对挥发性脂肪酸总量及成分的影响规律。结果表明,投配率为33%组的挥发酸总量最高,达13 701.67 mg.L-1,当投配率在14%~33%范围内变化时,挥发酸总量先随着投配率的增加而升高,但投配率增加到50%时挥发酸总量下降;各组的乙酸与丁酸之和百分含量均在80%以上,属于丁酸型发酵;投配率的变化影响挥发酸总量的变化,但不会引起产酸发酵类型的改变。

低剂量吉西他滨延时输注联合奈达铂治疗晚期非小细胞肺癌的临床观察

目的评价低剂量吉西他滨延时输注联合奈达铂治疗非小细胞肺癌(NSCLC)的疗效及耐受性。方法选择60例初诊局部晚期/转移性IIIB或IV期非小细胞肺癌患者,按1∶1随机分成两组,研究组:吉西他滨250 mg·m-2,civ 6 h,d1、d8;奈达铂80 mg·m-2,d1;q28d。对照组:吉西他滨1000 mg·m-2,30 min d1、d8;奈达铂80 mg·m-2,d1;q28d。观察和比较两组的治疗反应率(ORR)、无进展生存期(PFS)、总生存期(OS)及其毒副作用。结果研究组与对照组的ORR均为33.3%(P>0.975)。平均随访14个月,两组平均PFS分别为6.5个月和6.3个月(P>0.05);平均OS分别为12.45个月和12.49个月(P>0.05),差异均无统计学意义。两组血液学毒性反应多为轻中度,白细胞减少发生率分别为33.3%和46.6%,贫血发生率分别为33.3%和43.3%,血小板减少的发生率分别为10%和20%;胃肠道反应轻微;脱发相对较常见,发生率分别为87%和70%。所有毒副作用的差异均无统计学意义(P>0.05)。结论低剂量延时输注吉西他滨联合奈达铂治疗局部晚期/转移性NSCLC安全性好,且具有与标准剂量30 min输注方案相当的抗肿瘤效果。

小剂量阿加曲班在连续性血液净化治疗中的应用

目的探讨小剂量阿加曲班在连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)中的抗凝效果和出血事件。方法给予67例CRRT患者小剂量阿加曲班,首剂0.1μg/kg,微量泵持续追加0.05μg/(kg·min),测定实施治疗前、治疗结束后1 h、结束后2 h及治疗中每2 h凝血功能,采用评分方法评价血滤器凝血和穿刺(置管)处出血及血肿情况。结果血滤器凝血情况治疗前后无明显差异,穿刺(置管)处未见明显出血及血肿,活化部分凝血酶时间(APTT)和血浆凝血酶原时间(PT)治疗后1 h与治疗前有显著差异(P<0.05);治疗后2 h与治疗前无差异。治疗1 h时同时检测动脉端和静脉端PT和APTT值,两者差异有统计学意义(P<0.05)。结论达到治疗抗凝效果时,所需阿加曲班剂量较小,且未发生出血事件,故小剂量阿加曲班用于连续性肾脏替代治疗抗凝效果安全可靠。

慢性肾病患者行连续性肾脏替代治疗时抗菌药物治疗方案调整的分析与思考

危重患者行连续性肾脏替代治疗(CRRT)时,受CRRT模式、药物特性及患者病生理状态等因素的影响,抗菌药物的药代动力学和药效动力学参数改变,进而影响抗菌药物给药方案的调整。本文就1例行CRRT治疗的慢性肾病患者应用万古霉素的病例进行分析,探讨CRRT时抗菌药物剂量调整的影响因素。提供个体化给药方案,保证了患者抗感染治疗的安全性和有效性。