中国血液净化

中国血液净化 ›› 2017, Vol. 16 ›› Issue (07): 451-454.doi: 10.3969/j.issn.1671-4091.2017.07.005

• 临床研究 • 上一篇    下一篇

感染性休克患者持续性肾脏替代治疗时β-内酰胺类抗生素用药剂量分析

郑俊波1,戴青青1,温良鹤1,娄邵菲1,叶明1,姜雪松1,于凯江2   

  1. 1. 哈尔滨医科大学附属第二医院 重症医学科
    2. 哈尔滨医科大学附属第三医院 重症医学科
  • 收稿日期:2016-11-28 修回日期:2017-05-29 出版日期:2017-07-12 发布日期:2017-07-14
  • 通讯作者: 郑俊波 icuzhengjunbo@126.com E-mail:icuzhengjunbo@126.com
  • 基金资助:

    黑龙江省卫生厅科研课题(2012-596)

Dosing regimen of β-lactams for septic shock patients receiving continuous renal replacement therapy

  • Received:2016-11-28 Revised:2017-05-29 Online:2017-07-12 Published:2017-07-14

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摘要： 目的探讨β-内酰胺类抗生素常规用药方案在感染性休克患者持续性肾脏替代治疗(continuous renal replacement therapy,CRRT)时是否可以达到有效治疗浓度方法本研究纳入接受CRRT 的应用亚胺培南(imipenem,IPM)、哌拉西林他唑巴坦(piperacillin-tazobactam,TZP)或头孢吡肟(cefepime,FEP)的感染性休克患者。通过高效液相色谱法测量抗生素应用前、应用后0.5、1、2、4、6 和12h 的血药浓度。所采集得到的相关血液样本系列分为早期样本组(≤48h，在第1 次使用抗生素后起)和后期样本组(＞48h)2 组。结果共24 例患者入选，其中应用IPM 9 例，TZP 8 例和FEP 7 例。收集到45 组血液样本系列，其中IPM 15 组，TZP 16 组和FEP 14 组。47%接受IPM、75%接受TZP 和0%接受FEP 的患者血药浓度达到了治疗铜绿假单胞菌最小抑菌浓度(minimum inhibitory concentration，MIC)的四倍。结论对于接受CRRT 的感染性休克患者，β-内酰胺类抗生素的血药浓度不能完全达到对铜绿假单胞菌的杀菌效果，对于此类患者应考虑增加剂量或延迟给药时间以达到最佳的药物治疗浓度。

关键词: 感染性休克, 持续性肾脏替代治疗, β-内酰胺类抗生素

Abstract: Objective To investigate whether the routine regimen of β-lactams is appropriate for patients with septic shock receiving continuous renal replacement therapy (CRRT). Methods Septic shock patients treated with CRRT and receiving either imipene (IPM), piperacillin- tazobactam (TZP) or cefepime (FEP) were enrolled in this study. Serum concentrations of β- lactams were measured by high- performance liquid chromatography for samples taken before and after use of the antibiotics for 0.5, 1, 2, 4, 6 or 12 hours. Blood samples were then separated into early phase (samples taken＜48 hours after the first dose) and late phase (＞48 hours). Results Twenty-four patients (IPM, n=9; TZP, n=8; FEP, n=7) were enrolled in this study. Fortyfive blood samples (IPM, n=15; TZP, n=16; FEP, n=14) were collected. Serum concentrations more than 4 times above the minimal inhibitory concentration (MIC) for pseudomonas aeruginosa were found in 47% of the patients treated with IPM, in 75% with TZP, and in 0% with FEP. Conclusion In septic shock patients receiving CRRT, serum β-lactams concentrations for killing pseudomonas aeruginosa were insufficient in some cases. Higher doses or extended infusions should be considered for required serum concentrations.

Key words: Septic shock, Continuous renal replacement therapy, β-lactams