摘要
目的分析体外膜肺氧合(ECMO)时抗感染治疗药物监护的重点和难点。方法回顾性分析28例使用体外膜肺氧合治疗的危重症患者,统计患者的临床基本情况、病原学检出、抗感染药物使用和治疗药物监测情况。结果28例患者中男性20例,女性8例,平均年龄为44.7岁,平均ECMO持续时间20.3 d,使用ECMO前即有肝功能不全者16例、肾功能不全5例、心衰7例、低蛋白血症18例,12例合并使用持续肾脏替代治疗(CRRT),平均APACHEII评分为19.1分,SOFA评分为7.6分。ECMO撤离后最终治疗成功、存活患者7例,死亡、自动出院或放弃治疗21例。共培养出病原体55例,多数为多重耐药革兰阴性杆菌、碳青霉烯类药物耐药,治疗药物监测为万古霉素19例、碳青霉烯类11例、伏立康唑4例,血药浓度监测各品种均有超过半数未在治疗范围内。结论ECMO影响危重患者的血药浓度,应加强对该类患者的抗感染治疗药学监护。
Objective The emphases and difficulties of anti-infective drug monitoring in extracorporeal membrane oxygenation(ECMO)were analyzed.Methods A retrospective analysis of 28 critically ill patients treated with ECMO was performed.The clinical characteristics,pathogen detection,anti-infective agent's application,and therapeutic drug monitoring were statistically analyzed.Results Of the 28 patients,20 were male and 8 were female,with an average age of 44.7 years.The mean ECMO duration was 20.3 d.There were 16 patients with hepatic insufficiency,5 patients with renal insufficiency,and 7 patients with heart failure,18 cases of hypoproteinemia before ECMO.And there were 12 cases combined with CRRT;the average APACHE II score was 19.1 and SOFA score was 7.6.The overall outcomes were 7 patients survived,and 21 patients died or discharged automatically or abandoning therapy.A total of 55 pathogens were collected,most of which were multi-drug resistant Gram-negative bacilli and carbapenem-resistant.The therapeutic drugs application were vancomycin 19,carbapenems 11,voriconazole 4,etc.More than half of the TDM were not in the treatment range.Conclusion ECMO affects the blood concentration of anti-infective agents in critically ill patients and pharmaceutical care need to be strengthened.
作者
陈玥
黄絮
郭冬杰
CHEN Yue;HUANG Xu;GUO Dongjie(Clinical Pharmacist Center,People's Liberation Army General Hospital,100853 Beijing,China;Department of Respiratory and Critical Care Medicine,China-Japan Friendship Hospital,100029 Beijing,China;Department of Pharmacy,China-Japan Friendship Hospital,100029 Beijing,China)
出处
《药物评价研究》
CAS
2020年第6期1142-1146,共5页
Drug Evaluation Research
