| 陆瑾,曹露露,蒙钟经,等.美罗培南治疗重症感染病人的疗效及药物浓度的影响因素研究[J].安徽医药,2023,27(4):830-834. |
| 美罗培南治疗重症感染病人的疗效及药物浓度的影响因素研究 |
| Study on factors affecting the efficacy and drug concentration of meropenem in the treatment of patients with severe infections |
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| DOI：10.3969/j.issn.1009-6469.2023.04.046 |
| 中文关键词: 美罗培南 细菌感染 年龄因素 肌酸酐 药物浓度 疗效 |
| 英文关键词: Meropenem Bacterial infection Age factor Creatinine Drug concentration Curative effect |
| 基金项目:江苏省药学会 ?奥赛康医院药学基金( A201835)；南京市药学会 ?常州四药医院药学科研基金( 2019YX027) |
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| 摘要点击次数: 1997 |
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| 中文摘要: |
| 目的研究影响重症加强护理病房( ICU)重症感染病人美罗培南疗效及其药物浓度的因素。方法采用回顾性分析方法，选取南京市大厂医院 2018年 1月至 2019年 12月 ICU出院或转出的使用美罗培南的重症感染病人 95例，收集病人病史资料及相关的病理生理指标，包括体质量、性别、年龄、剂量、血肌酐及原发病等相关信息，通过菌株分布、感染情况、临床有效率及药代动力学 /药效学( PK/PD)效应、统计分析影响美罗培南疗效及药物浓度的因素。结果 95例病人中，根据感染指标与疗效判断，最终好转 64例，好转率为 67.37%。重症感染的病人中，美罗培南 PK/PD靶目标应达到 80% T?MIC或更高。 Spearman相关分析结果显示美罗培南谷值与年龄( r=0.43，P<0.001)、血肌酐( r=0.43，P<0.001)、肌酐清除率( r=?0.53，P<0.001)和出入量( r=?0.30，P=0.004)相关；峰值与体质量( r=?0.22，P=0.003)、每日总剂量( r=?0.21，P=0.045)和出入量(r=?0.25，P=0.016)相关。多重线性回归结果显示:年龄( t=2.02，P=0.046)、血肌酐( t=7.17，P<0.001)是谷值的影响因素，谷值 =?7.619+0.104×年龄 +0.111×血肌酐；每日总剂量是峰值的影响因素( t=1.99，P=0.049)，峰值 =28.211+4.076×每日总剂量。结论重症感染病人美罗培南的药物浓度受年龄、血肌酐及每日总剂量的影响，有必要根据病人特定的条件，个体化设计美罗培南的用法用量来提高其临床疗效。 |
| 英文摘要: |
| Objective To study the factors that affect the efficacy and drug concentration of meropenem in patients with severe infections in the intensive care unit (ICU).Methods A retrospective analysis was used to select 95 patients with severe infections discharged or transferred from the ICU with meropenem from January 2018 to December 2019 at Nanjing Dachang Hospital; to collect patient history data and relevant pathophysiological indicators, including information related to body mass, sex, age, dose, blood creatinine and primary disease; and to statistically analyze the factors affecting the efficacy and drug concentration of meropenem throughstrain distribution, infection status, clinical effectiveness and pharmacokinetics/pharmacodynamics (PK/PD) effects.Results Amongthe 95 patients, 64 were finally improved according to the infection index and curative effect, with an improvement rate of 67.37%. In patients with severe infection, the PK/PD target of meropenem should reach 80% T?MIC or higher. Spearman′s correlation analysisshowed that meropenem valley values correlated with age (r=0.43,P<0.001), serum creatinine (r=0.43,P<0.001), creatinine clearance (r= ?0.53,P<0.001) and intake and output (r=?0.30,P=0.004), with statistically significant differences. The peak values were correlated with body weight (r=?0.22,P=0.003), total daily dose (r=?0.21,P=0.045) and dose intake and output (r=?0.25,P=0.016), with statistically significant differences. Multiple linear regression results showed that age (t=2.02,P=0.046) and serum creatinine (t=7.17,P<0.001) were theinfluencing factors for the valley value, and the valley value =7.619+0.104×age+0.111×serum creatinine. The total daily dose was the influencing factor the peak value (t=1.99,P=0.049), and the peak value=28.211+4.076×total daily dose.Conclusions The concentration of meropenem in patients with severe infection is affected by age, serum creatinine and total daily dose. It is necessary to design the dosage of meropenem individually according to patient-specific conditions to improve its clinical efficacy. |
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