目的:对急性肾损伤并肺部感染患者临床抗菌方案进行评价和调整。方法:利用PK/PD理论优化抗菌治疗的综合评价参数的定量范围,以及根据CCr值(内生肌酐清除率)对用药方案进行调整。结果及结论:急性肾损伤初期处于肾衰阶段的患者,CCr大幅下降,全程使用PIP/TAZ(哌拉西林/他唑巴坦)4.5 g q8h的给药方案,其给药剂量或给药频次明显超量。对该类患者,建议初期采用PIP/TAZ 4.5 g q24h~q36h的给药方案,逐步过渡到4.5 g q8h。 相似文献
Introduction: Clinical trials concerning the effects of nicorandil in stable coronary artery disease (CAD) remain controversial. This study sought to evaluate the clinical outcomes of nicorandil following elective percutaneous coronary intervention (PCI).
Areas covered: A meta-analysis including eligible randomized controlled trials (RCTs) with data on the nicorandil in stable CAD from Pubmed, EMBase, and Cochrane library (up to March 2018) was conducted. The primary end points were postprocedural incidence of myocardial infarction (MI) and contrast-induced nephropathy (CIN). The second end point was major adverse cerebrovascular and cardiovascular events (MACCE). Fourteen RCTs with a total of 1947 elective CAD patients were selected. Nicorandil significantly reduced the incidence of MI [n = 8; relative risk (RR) = 0.58; P = 0.001; I2 = 33.7%], and CIN (n = 5; RR = 0.36; P < 0.00001; I2 = 15.4%). However, There was no lowered risk of MACCE in nicorandil-treated patients [n = 10; odds RR = 0.75; P = 0.19; I2 = 0.0%]. Subsequent trial sequential analyses confirmed the effect of nicorandil on MI and CIN in PCI.
Expert commentary: The present systematic review and meta-analysis suggests that nicorandil could improve clinical outcomes in terms of perioperative MI and CIN. However, the effect of nicorandil on the MACCE risk is not obvious. Future high-quality, large-scale clinical trials should majorly concern about the long-term clinical effect of nicorandil. 相似文献