摘要
目的:评价定量药理学软件在制定重症病人万古霉素个体化给药方案中的应用价值。方法:采用经典药动学软件Vancomycin Calculator(advanced vancomycin pharmacokinetics tool)和群体药动学软件Java PK for desktop(JPKD)相结合的方法,根据病人个体情况(性别、年龄、身高、体重、血肌酐值、疾病状况),计算万古霉素的初始给药剂量、初始预测浓度,利用贝叶斯(Bayesian)反馈法确定实际给药剂量,计算实际给药剂量的稳态血药谷浓度(Css,min)预测值。用药5个半衰期万古霉素血浓度达稳态后,在给药前30min采血,应用荧光偏振免疫法测定血浓度,此为(Css,min)的实测值。用双变量相关分析统计(Css,min)预测值与(Css,min)实测值的相关性。结果:共为60例重症病人制定了个体化给药方案,收集到60例病人的63例次万古霉素(Css,min)数据,(Css,min)预测值为(14.02±5.11)μg/ml,(Css,min)实测值为(13.30±6.22)μg/ml,两者偏差值为(0.73±3.79)μg/ml。(Css,min)预测值与实测值具有显著相关性(r=0.794,P<0.001)。(Css,min)整体实际达标43例次,达标率68.3%。结论:经典药动学和群体药动学软件可以根据重症病人的个体情况制定万古霉素的个体化给药方案,具有良好的血药浓度预测性。
Objective：To evaluate the value of quantitative pharmacological software in the development of personalized dosage regimen of vancomycin for critically ill patients.Methods：By combining advanced vancomycin pharmacokinetics tool and Java PK for desktop,the initial dosage of vancomycin was calculated for the initial predicted trough concentration of vancomycin based on patient＇s information,including gender,age,height,weight,serum creatinine and disease state.Then,actual drug doses and predicted serum steady trough concentration（Css,min）of vancomycin were calculated by Bayesian.The serum concentration of vancomycin became stable after 5half-life.Blood samples were taken 30 min before injection of the drug.The fluorescence polarization immunoassay was used to determine the concentration of actual vancomycin（Css,min）.The correlation of actual（Css,min）and predicted（Css,min）was analyzed statistically by means of bivariate.Results：Sixty three blood samples with serum trough concentration of vancomycin were collected from sixty patients.The predicted value of（Css,min）was（14.02±5.11）μg/ml and the actual value of（Css,min）was（13.30±6.22）μg/ml.The serum trough concentration deviation value was（0.73±3.79）μg/ml.The predicted（Css,min）of vancomycin was significantly related to the actual value（r=0.794,P0.001）.The overall actual success rate was 68.3%（43/63）.Conclusion：Classic pharmacokinetic and population pharmacokinetics software could provide individualized dosage regimen of vancomycin in critically ill patients,and display good blood drug concentration prediction.
作者
方洁
刘利艳
黄洁
程齐俭
FANG Jie LIU LiYan HUANG Jie CHENG QiJian(Department of Pharmacy, Ruijin Hospital Affiliated to School of Medicine,Shanghai Jiaotong University, Shanghai 200025, China Department of Pharmacy, Jiangxi Tumor Hospital, Nanchang 330029, China Department of Critical Care Medicine, Ruijin Hospital Affiliated to School of Medicine, Shanghai Jiaotong University, Shanghai 200025, China Department of Respiratory Medicine, Ruijin North Hospital Affiliated to School of Medicine, Shanghai Jiaotong University, Shanghai 201801, China)
出处
《药学服务与研究》
CAS
2017年第3期179-182,共4页
Pharmaceutical Care and Research
基金
上海申康医院发展中心项目(SHDC12015901)
关键词
定量药理学
万古霉素
给药方案
优化
quantitative pharmacology
vancomycin
dosage regimen
optimization
