中国实用外科杂志

中国实用外科杂志

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脓毒症对抗生素药代动力学和药效动力学影响

唐建国，李    虎，杨春辉   

  1. 复旦大学附属上海市第五人民医院，上海 200240
  • 出版日期:2016-02-01 发布日期:2016-01-29

  • Online:2016-02-01 Published:2016-01-29

摘要：

脓毒症是感染引起的全身炎性反应综合征，是外科手术尤其是腹部手术后较常见的严重并发症之一，具有较高的病死率。早期、恰当的抗生素治疗是降低脓毒症病死率的主要措施，但由于脓毒症病人常伴有毛细血管渗漏综合征、体液重新分配和低蛋白血症等，使抗生素药代动力学（PK）参数（如表观分布容积和药物清除率）发生变化，常规剂量的抗生素难以达到药代动力学和药效动力学（PK/PD）目标值，导致临床治疗失败。因此，根据脓毒症状态下抗生素PK/PD特点适当调整抗生素剂量或改善药物输注方式，优化抗生素使用，以达到有效的PK/PD目标值，对降低脓毒症病死率具有重要意义。

关键词: 脓毒症, 药代动力学, 药效动力学, 全身炎性反应综合征

Abstract:

Influence of sepsis on pharmacokinetic and pharmacodynamic of antibiotics        TANG Jian-guo, LI Hu，YANG Chun-hui. The Fifth People’s Hospital of Shanghai, Fudan University, Shanghai 200240, China
Corresponding author: TANG Jian-guo, E-mail: tangjianguo@5thhospital.com
Abstract    Sepsis is the systemic inflammatory response syndrome caused by infection，which is a common complication following surgery，especially abdominal surgery，with higher mortality. Early and appropriate antimicrobial treatment is the predominant intervening measure to decrease patients’ mortality. However，the pathophysiologic changes during sepsis such as systemic capillary leak syndrome，altered shift of body fluid and hypoalbuminemia can lead to changes in pharmacokinetic/pharmacodynamic（PK/PD） parameters such as apparent volume of distribution（Vd） and clearance（CL） that affect the achievement of PK targets and treatment failure with routine dose. Therefore，it is crucial to reduce patients` mortality by adjusting antimicrobial dose and improving drug infusion to optimize antimicrobial therapy according to characteristics of PK/PD during sepsis.

Key words: sepsis, pharmacokinetic, pharmacodynamic, systemic inflammatory response syndrome