利奈唑胺用于危重症感染患者的合理性评价及影响其血药浓度的相关因素分析

发布时间：2018-06-11 12:07

本文选题：利奈唑胺 + 血药浓度　；参考：《安徽医科大学》2017年硕士论文

【摘要】：目的分析注射用利奈唑胺临床应用合理性,对应用利奈唑胺注射剂治疗感染的危重症患者进行利奈唑胺血浆浓度的监测,并分析影响血药浓度的相关因素,为临床更加安全有效的使用利奈唑胺提供参考。方法统计2015年1月到2016年11月使用利奈唑胺注射剂的临床病历,填写《利奈唑胺临床使用调查表》和《抗菌药物合理应用评价标准表》,对不合理使用利奈唑胺注射剂的情况进行分析,并对影响治疗效果和产生不良反应的因素进行研究。利用高效液相色谱法测定患者血浆中利奈唑胺的浓度,并分析肝、肾功能等因素对利奈唑胺血药浓度的影响。结果共收集汇总128例临床病历信息,治疗结束时细菌清除的患者共102例定义为治疗有效组;细菌部分清除、未清除、菌群交替的患者共26例定义为治疗无效组,细菌清除率最高的科室为呼吸内科95.24%,最低的为肿瘤科64.29%,128份临床病历中合理用药68例(53.13%)、基本合理34(26.56%)、不合理用药26例(20.31%),两组患者在用药天数、肝功能、肾功能、发生不良反应方面存在显著性差异。共20位患者发生药品不良反应,其中11例发生血小板减少不良反应,无效组中发生不良反应的8例患者均出现肝、肾功能的异常。共监测89例患者的血浆利奈唑胺浓度,肝、肾功能异常的患者与肝、肾功能正常的患者的利奈唑胺血浆浓度具有显著性差异,且在肾功能异常组利奈唑胺血浆浓度个体差异较大,最高可达到8.70μg·ml-1,最低只有0.94μg·ml-1。共有9例患者出现利奈唑胺谷浓度小于2μg·ml-1最低抑菌浓度(minimal inhibitory concentration,MIC)的情况。结论本文建立的利奈唑胺检测方法准确可靠,操作简便,灵敏度高,可用于临床利奈唑胺血药浓度的检测。利奈唑胺注射剂的使用主要存在无药敏试验用药、用药疗程过短或过长、联合用药无指证等不合理现象。肝、肾功能异常的重症感染患者利奈唑胺血浆浓度个体差异大,肾功能的影响主要作用于利奈唑胺的排泄方面,而肝功能的影响主要是由于重症患者白蛋白水平的下降导致其血浆蛋白结合率的下降使总体的清除增加,最终使血药浓度下降。在对利奈唑胺所致不良反应的分析中发现不良反应的发生与肾功能异常有关。综合考虑以上因素才能为进一步规范利奈唑胺的合理使用和制定个性化给药方案提供建议和参考。
[Abstract]:Objective to analyze the rationality of clinical application of linazolamide for injection, to monitor the plasma concentration of linazolidomide in critically ill patients with infection, and to analyze the related factors affecting the serum drug concentration. To provide a reference for the safe and effective use of linazolamide in clinical practice. Methods from January 2015 to November 2016, the clinical records of the patients treated with linazolamide injection were statistically analyzed. To fill out the questionnaire of clinical use of linazolamide and the evaluation standard of rational use of antimicrobial agents, to analyze the situation of improper use of linazolamide injection, and to study the factors affecting the therapeutic effect and adverse reactions. High performance liquid chromatography (HPLC) was used to determine the concentration of linazolamide in plasma, and the effects of liver and kidney function on the concentration of linazolamide in plasma were analyzed. Results A total of 128 clinical records were collected and collected. 102 patients with bacterial clearance at the end of the treatment were defined as the effective treatment group, and 26 patients who were partially cleared, not cleared, and alternately bacteria were defined as the ineffective treatment group. The department with the highest bacterial clearance rate was the Department of Respiratory Medicine 95.24m, the lowest was the Department of Oncology (64.29 / 128), the lowest was 68 cases of rational use of drugs (53.1313), the basic rational use of the drug was 3426.56%, the irrational use of the drug was 26 cases (20.31%), the days of medication, liver function, and renal function in the two groups. There were significant differences in adverse reactions. A total of 20 patients had adverse drug reactions, 11 of them had adverse effects of thrombocytopenia, 8 of the ineffective group had abnormal liver and renal function. There were significant differences in the plasma concentration of linazolamide between the patients with abnormal liver and kidney function and those with normal liver and renal function. In the renal dysfunction group, there was a significant difference in the plasma concentration of linazolamide, the highest was 8.70 渭 g ml-1, and the lowest was 0.94 渭 g ml-1. A total of 9 patients were found to have minimal inhibitory concentration of less than 2 渭 g ml-1. Conclusion the method established in this paper is accurate, reliable, simple and sensitive, and can be used to detect the serum concentration of lenazolidomide in clinic. The use of linazolamide injection is mainly caused by no drug sensitivity test, too short or too long course of treatment, no finger evidence and so on. In severe infection patients with abnormal liver and kidney function, the plasma concentration of linazolamide varies greatly. The effect of renal function is mainly related to the excretion of linazolamine. The effect of liver function was mainly due to the decrease of albumin level in severe patients, which resulted in the decrease of plasma protein binding rate and the increase of total clearance, and finally the decrease of serum drug concentration. In the analysis of adverse reactions caused by linazolamide, it was found that adverse reactions were related to abnormal renal function. Comprehensive consideration of the above factors can provide suggestions and references for further standardizing the rational use of linazolamide and for formulating individualized drug administration protocols.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R969

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