摘要目的 探讨亚胺培南治疗药物监测在重症监护患者中的应用情况,为重症患者使用亚胺培南提供依据。方法 采用横断面调查的方法,收集2016年1月1日到2018年12月31日共3年我院重症监护室(ICU)67例接受亚胺培南治疗药物监测的患者临床资料,运用SPSS21.0统计软件对71例次治疗药物监测数据(血药浓度、f%T＞MIC)以及相关临床数据进行分析。结果 全部71次治疗药物监测中,f%T＞MIC≥40%的共37例次(52.11%),＞70%的共26例次(36.62%);有10例次(14.08%)监测达到100%。0.25 g q6h全部病例f%T＞MIC均超过70%。其他给药方案中,f%T＞MIC＞40%比例最高的给药方案是1 g q12h(66.67%),f%T＞MIC＞70%比例最高的给药方案是0.5 g q8h(43.59%)。将患者按f%T＞MIC的结果分为3组:≤40%组、＞40%~70%组、＞70%组,只有＞70%组用药前后患者的感染指标全部呈下降趋势,其中体温显著性下降(P=0.004),而≤40%组用药后较用药前平均PCT水平反而升高(但无统计学差异,P=0.46)。在肾功能方面,只有f%T＞MIC＞70%组血肌酐用药后较用药前呈下降趋势,但无显著性差异(P=0.285)。接受肾脏替代治疗的患者,CRRT组的血药浓度略高于非CRRT组,f%T＞MIC差异不大,且均无统计学差异(P=0.376,P=0.209,P=0.988)。结论 重症监护患者亚胺培南f%T＞MIC达标情况不理想。对于重症患者,当亚胺培南f%T＞MIC＞70%,抗菌效果较好。
Abstract：OBJECTIVE To explore the application of therapy drug monitoring of imipenem in ICU, and to provide evidence for the use of imipenem in critically ill patients. METHODS A cross-sectional survey was conducted to collect clinical data of 67 patients receiving therapeutic drug monitoring of imipenem in ICU from January 1, 2016 to December 31, 2018. Using SPSS21.0 statistical software, 71 cases of therapeutic drug monitoring data (blood drug concentration, f%T>MIC) and related clinical data were analyzed. RESULTS Of all 71 cases of therapeutic drug monitoring, there are 37 cases (52.11%) f%T＞MIC≥40%,26 cases(36.62%)f%T＞MIC＞70%,and 10 cases(14.08%) f%T＞MIC=100%. f%T＞MIC of all cases with 0.25 g q6h were ＞70%. Among other dosage regimens, the highest proportion of f%T>MIC>40% was 1 g q12h (66.67%) and the highest proportion of f%T>MIC>70% was 0.5 g q8h(43.59%). According to different f%T>MIC, those patients were divided into ≤40% group, >40%-70% group and>70%group. Only group>70% showed a downward trend in the infection index of patients before and after medication. The body temperature decreased significantly (P=0.004), while the average PCT level of group < 40% increased after medication (P=0.46). In terms of renal function, only f%T>MIC>70% group showed a downward trend in serum creatinine after treatment, but there was no significant difference (P=0.285). The serum drug concentration in CRRT group was slightly higher than that in non-CRRT group, and there was no significant difference in f%T>MIC (P=0.376, P=0.209, P=0.988). CONCLUSION The level of f%T>MIC of imipenem in ICU is unsatisfactory. For critically ill patients, when imipenem f%T>MIC>70%, the antimicrobial effect is better.
郭冬杰, 李朋梅, 陈文倩, 张相林. 重症监护患者亚胺培南治疗药物监测真实世界横断面调查[J]. 中国药学杂志, 2020, 55(8): 650-655.
GUO Dong-jie, LI Peng-mei, CHEN Wen-qian, ZHANG Xiang-lin. Cross Sectional Survey on Therapeutic Drug Monitoring of Imipenem in Critically Ill Patients of the Real World. Chinese Pharmaceutical Journal, 2020, 55(8): 650-655.
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2020, Vol. 55 
