阿米卡星在严重败血症患者体内的药代动力学研究

目的：初步探讨25 mg·kg －1的阿米卡星在重症监护室（ICU）患者体内的药代动力学。方法纳入符合条件的30例革兰阴性（G －）败血症患者进行阿米卡星药物治疗研究，通过非房室模型计算每名患者的阿米卡星的药代动力学。结果阿米卡星在 G －败血症患者体内平均药物分布为（0．36±0．07）L·kg －1，平均血液清除率为（3．88±0．97）mL·min －1·kg －1。肌酐清除率与血清肌酸酐（SCr）相关性具有统计学意义。结论对 ICU 患者应用高剂量阿米卡星（≥25 mg·kg －1）需要考虑败血症对血液动力学的影响，需要密切监测败血症血液药物浓度变化，关键要考虑到重症患者体内药代动力学与普通人群是不同的。

Amikacin pharmacokinetics in critically ill patients

Objective To examine the relationship between amikacin disposition kinetics after a 25 mg·kg -1 loading dose and hemo-dynamic response to sepsis,as well as clinical parameters,in a population of critically ill patients.Methods In this research,30 pa-tients who were candidate to amikacin therapy following Gram negative sepsis were enrolled.The pharmacokinetic profile of amikacin by a non-compartmental model was calculated for each patient.Results Mean volume of distribution was (0.36 ±0.07)L·kg -1 and mean serum amikacin clearance was (3.88 ±0.97)mL·min -1 ·kg -1 .In the case of Vd,APACHE II score correlation was signifi-cant.In the case of amikacin clearance,correlation between two covariates including creatinine clearance and SCr was found significant. Conclusions It appears necessary to use higher amikacin dosage (≥ 25 mg·kg -1 )considering hemodynamic response of patients to sepsis.To achieve therapeutic drug concentration a close drug monitoring and a shift from the population mean toward a value more rep-resentative of the critically ill patient subpopulation is crucial.