药物监测美罗培南对脓毒症临床治疗效果的影响

摘要

目的 探讨美罗培南治疗药物监测(therapeutic drug monitoring,TDM)对脓毒症临床疗效的影响.方法 选取我院应用美罗培南抗感染治疗的脓毒症113例,根据是否进行TDM,分为观察组(n=57)和对照组(n=56).比较两组治疗第1天和第7天的实验室炎症指标和生化指标及病情严重程度变化,记录不良反应发生情况及28 d病死率.结果 与本组治疗第1天比较,两组治疗第7天C-反应蛋白、降钙素原、白细胞、中性粒细胞百分比、序贯器官衰竭(SOFA)评分、急性生理与慢性健康评定标准(APACHE)Ⅱ评分及观察组治疗第7天天冬氨酸转氨酶、胆红素水平均降低,差异有统计学意义(P<0.05);与对照组比较,观察组治疗第7天C-反应蛋白、SOFA评分与APACHEⅡ评分均降低,差异有统计学意义(P<0.05).两组不良反应比较差异无统计学意义(P=0.548);观察组、对照组28d病死率分别为7.0％、19.6％,比较差异有统计学意义(P=0.048).结论 常规美罗培南治疗脓毒症往往不足以达到药代及药效动力学目标,加大剂量或可致毒性及不良反应增加,需依据TDM制定个体化给药方案.%Objective To investigate the effects of therapeutic drug monitoring of Meropenem on clinical ef-ficacy of sepsis treatment. Methods A total of 113 patients admitted and treated in our hospital were included in this study, who were divided into observation group (n=57) and control group(n=56) according to application of TDM of Meropenem. The inflammatory markers and biochemical indexes of the laboratory test as well as the severity of the disease were compared between the two groups at 1 and 7 days. In addition, the occurrence of adverse reac-tions and the 28-day mortality were recorded. Results The levels of C-reactive protein ( CRP ) , procalcitonin, WBC, neutrophilic granulocyte percentage, sequential organ failure assessment ( SOFA) , acute physiology and chro-nic health evaluation ( APACHE) scoring systemⅡof both groups as well as the levels of AST and bilirubin in obser-vation group were decreased at 7 days, as compared with those at 1 day, and the difference was statistically signifi-cant (P<0.05). In observation group, the levels of CRP, SOFA score and APACHEⅡscore were decreased at 7 days, compared with those in control group, suggesting significant differences (P<0.05). Specifically, APACHEⅡwas significantly lower at 7 days than at 1 day, showing significant differences. There was no significant difference in adverse effects between the two groups ( P=0.548 ) . The 28-day mortality rates in the observation group and the control group were 7. 0％ and 19. 6％, respectively. The difference was statistically significant (P=0.048). Con-clusion Routine doses of Meropenem are often inadequate to achieve pharmacokinetic/pharmacodynamics goals in the treatment of sepsis, however, increased dose may lead to an increase in toxicity and side effects. Therefore, an individualized dosing regimen should be developed based on TDM.