重症患者替加环素血药浓度的监测与PK/PD达标率的研究

Monitor the Tigecycline Plasma Concentration and Study on the PK/PD Compliance Rate in Critically Ill Patients

关键词:  替加环素  重症患者  PK/PD  达标率

Key words:  tigecycline  critically ill patients  PK/PD  compliance rate

摘要:

目的 对使用替加环素治疗的重症患者血药浓度进行监测，计算其PK/PD达标率，为临床更加合理地使用替加环素提供参考。方法 采用回顾性分析方法，将纳入的45例重症患者分为高、低剂量组，收集第7次给药后的谷浓度、中浓度及峰浓度（C_min、C_1/2t、C_max），计算2组AUC_0-24、AUIC值及不同感染部位PK/PD达标率，观察2组不良反应情况。结果 高剂量组的C_min、C_1/2t、C_max、AUC_0-24及PK/PD总达标率均显著高于低剂量组（P<0.05）。高剂量组在肺部、腹腔、皮肤及软组织感染的达标率均高于低剂量组，其中2组在肺部感染的达标率具有显著性差异（P<0.05）。2组随着病原菌最低抑菌浓度（minimum inhibitory concentration，MIC）的增高，PK/PD达标率显著下降。45例患者中发生不良反应共7例，2组不良反应的发生率无显著性差异。结论 替加环素对重症患者安全性较好，对于重症患者肺部感染和皮肤及软组织感染，特别是具有高MIC的病原菌感染，可适当地提高替加环素的剂量。

Abstract:

OBJECTIVE To monitor the plasma concentration of tigecycline in critically ill patients and calculate the PK/PD compliance rate to provide a reference for using tigecycline more rationally in clinic. METHODS The 45 critically ill patients included were divided into high and low dose groups. The trough concentration, intermediate concentration, and peak concentration(C_min, C_1/2t, C_max) after the 7th administration were collected. Caculated the AUC_0-24 and AUIC values and PK/PD compliance rate at different infection sites, and observed 2 groups of adverse reaction conditions. RESULTS The C_min, C_1/2t, C_max, AUC_0-24, and the overall compliance rate of PK/PD in the high-dose group were significantly higher than those in the low-dose group(P<0.05). The compliance rate of high-dose group in lung, abdominal cavity, skin and soft tissue infection was higher than that in low-dose group, and there was a significant difference in the compliance rate between the 2 groups in pulmonary infection(P<0.05). With the increase of the minimum inhibitory concentration(MIC) of pathogenic bacteria, the PK/PD compliance rate decreased significantly in the 2 groups. A total of 7 adverse reactions occurred in 45 patients. There was no significant difference in the incidence of adverse reactions between the 2 groups. CONCLUSION Tigecycline is safer in critically ill patients. Higher doses shall be given when tigecycline is used for pulmonary infections and skin and soft tissue infections, especially pathogenic bacteria with high MIC.