国际呼吸杂志
國際呼吸雜誌
국제호흡잡지
INTERNATIONAL JOURNAL OF RESPIRATION
2012年
12期
906-909
,共4页
臧宗美%王英%张睢扬%常艳%王东霞
臧宗美%王英%張睢颺%常豔%王東霞
장종미%왕영%장휴양%상염%왕동하
药代/药效学%蒙特卡洛模拟%延长输注%达标概率
藥代/藥效學%矇特卡洛模擬%延長輸註%達標概率
약대/약효학%몽특잡락모의%연장수주%체표개솔
Pharmacokinetics/pharmacodynamics%Monte Carlo simulation%Prolonged infusion therapy%Probability of target attainment
目的 研究老年重症患者哌拉西林/他唑巴坦延长输注的血药浓度-时间曲线,并计算哌拉西林/他唑巴坦的药代/药效学参数.方法 收集在重症医学科住院且满足入组条件的老年重症患者5例,给予哌拉西林/他唑巴坦(4.5 g/q8h)3 h延长输注治疗,于注射开始的0h、0.25 h、0.5h、1h、2h、3h、4h、5h、6h、8h采静脉血2 ml,3 500 r/min离心10 min,取上清液,置于-23℃冰箱中保存备检.用超高效液相色谱法-串联质谱法测定哌拉西林/他唑巴坦的血药浓度,应用noncompartmental模型估计哌拉西林/他唑巴坦的药代学参数,利用蒙特卡洛模拟10 000例患者的治疗·比较哌拉西林/他唑巴坦传统输注(0.5 h)与延长输注(3～4 h)下各MIC值(1～64 μg/ml)的达标概率(PTA),将％fT、MIC≥50％设置为有效药效学目标.结果 哌拉西林的血浆峰浓度、半衰期、分布容积、清除率分别为(97.64±27.16) mg/L、(2.32±0.81)h、(30.51±15.2)L、(9.27±2.69) L/h.在哌拉西林/他唑巴坦4.5 g/q8h.3h延长输注中,当MIC≤16 μg/ml时.PTA达到或接近100％；MIC=32 ug/ml时,PTA为42.54％.结论 本文描述了哌拉西林/他唑巴坦在老年重症患者的药代学参数,这与已发表文献的结果明显不同.蒙特卡洛模拟显示,老年重症患者采用哌拉西林/他唑巴坦4.5 g/q8h.3h输注可以获得较佳的药效学目标,尤其在MIC≤16μg/ml时.
目的 研究老年重癥患者哌拉西林/他唑巴坦延長輸註的血藥濃度-時間麯線,併計算哌拉西林/他唑巴坦的藥代/藥效學參數.方法 收集在重癥醫學科住院且滿足入組條件的老年重癥患者5例,給予哌拉西林/他唑巴坦(4.5 g/q8h)3 h延長輸註治療,于註射開始的0h、0.25 h、0.5h、1h、2h、3h、4h、5h、6h、8h採靜脈血2 ml,3 500 r/min離心10 min,取上清液,置于-23℃冰箱中保存備檢.用超高效液相色譜法-串聯質譜法測定哌拉西林/他唑巴坦的血藥濃度,應用noncompartmental模型估計哌拉西林/他唑巴坦的藥代學參數,利用矇特卡洛模擬10 000例患者的治療·比較哌拉西林/他唑巴坦傳統輸註(0.5 h)與延長輸註(3～4 h)下各MIC值(1～64 μg/ml)的達標概率(PTA),將％fT、MIC≥50％設置為有效藥效學目標.結果 哌拉西林的血漿峰濃度、半衰期、分佈容積、清除率分彆為(97.64±27.16) mg/L、(2.32±0.81)h、(30.51±15.2)L、(9.27±2.69) L/h.在哌拉西林/他唑巴坦4.5 g/q8h.3h延長輸註中,噹MIC≤16 μg/ml時.PTA達到或接近100％；MIC=32 ug/ml時,PTA為42.54％.結論 本文描述瞭哌拉西林/他唑巴坦在老年重癥患者的藥代學參數,這與已髮錶文獻的結果明顯不同.矇特卡洛模擬顯示,老年重癥患者採用哌拉西林/他唑巴坦4.5 g/q8h.3h輸註可以穫得較佳的藥效學目標,尤其在MIC≤16μg/ml時.
목적 연구노년중증환자고랍서림/타서파탄연장수주적혈약농도-시간곡선,병계산고랍서림/타서파탄적약대/약효학삼수.방법 수집재중증의학과주원차만족입조조건적노년중증환자5례,급여고랍서림/타서파탄(4.5 g/q8h)3 h연장수주치료,우주사개시적0h、0.25 h、0.5h、1h、2h、3h、4h、5h、6h、8h채정맥혈2 ml,3 500 r/min리심10 min,취상청액,치우-23℃빙상중보존비검.용초고효액상색보법-천련질보법측정고랍서림/타서파탄적혈약농도,응용noncompartmental모형고계고랍서림/타서파탄적약대학삼수,이용몽특잡락모의10 000례환자적치료·비교고랍서림/타서파탄전통수주(0.5 h)여연장수주(3～4 h)하각MIC치(1～64 μg/ml)적체표개솔(PTA),장％fT、MIC≥50％설치위유효약효학목표.결과 고랍서림적혈장봉농도、반쇠기、분포용적、청제솔분별위(97.64±27.16) mg/L、(2.32±0.81)h、(30.51±15.2)L、(9.27±2.69) L/h.재고랍서림/타서파탄4.5 g/q8h.3h연장수주중,당MIC≤16 μg/ml시.PTA체도혹접근100％；MIC=32 ug/ml시,PTA위42.54％.결론 본문묘술료고랍서림/타서파탄재노년중증환자적약대학삼수,저여이발표문헌적결과명현불동.몽특잡락모의현시,노년중증환자채용고랍서림/타서파탄4.5 g/q8h.3h수주가이획득교가적약효학목표,우기재MIC≤16μg/ml시.
Objective To describe the plasma concentration-time profiles and to evaluate the pharmacokineties and pharmacodynamics of piperacillin/ tazobactam in hospitalised aged critically ill patients administered by prolonged infusion.Methods Five ICU patients received 4.5 g every 8 h (q8h),infused over 3 h.2 ml blood samples were collected at the time of 0 h,0.25 h,0.5 h,1 h,2 h,3 h,4 h,5 h,6 h,8 h,respectively,then centrifugated 10 minutes with 3 500 r/min.The supernatant.was extracted and stored at -23 ℃.Piperacillin and tazobactam concentrations in plasma were measured using ultra performance liquid chromatography tandem mass spectrometry,and pharmacokinetic parameters were determined by noncompartmental methods.Monte Carlo simulations (10 000 patients) were performed to calculate the probability of target attainment (PTA) at MIC ranging from 1 μg/ml to 64 μg/ml.The pharmacodynamic target was free piperacillin concentration remaining above the MIC for 50％ of the dosing interval.Results The maximum serum concentrations,half-life,volume of distribution and clearance of piperacillin were (97.64 ± 27.16) mg/L,(2.32 ± 0.81 ) h,(30.51 ± 15.2) L,(9.27 ± 2.69) L/h,respectively.In the Monte Carlo simulation study,the PTA was 100％ and 42.54％ at MIC≤16 μg/ml and 32 μg/ml,respectively.Conclusions This paper represents the population pharmacokinetics of piperacillin/tazobactam in aged critically ill patients in ICU.The data describe different pharmacokinetic parameters from those observed in other patient populations.The results of the Monte Carlo simulations suggest that piperacillin/tazobactam 4.5 g q8h infused over 3 h provides excellent target attainment for bacterial pathogens,especially at MIC≤16 μg/ml.
