体外膜肺氧合对抗菌药物药代动力学影响的研究进展

体外膜肺氧合（ECMO）技术是一种为严重呼吸或心力衰竭的重症患者提供生命支持的有效辅助手段。较多研究报道ECMO可能通过对药物的吸附、增大药物的表观分布容积及改变药物的清除率等方式来影响部分药物的代谢过程。本文总结了ECMO对抗细菌药物和抗真菌药物药代动力学影响的现有体内及体外研究。在抗细菌药物中,当前研究建议ECMO期间需要增加替考拉宁、亚胺培南和利奈唑胺的常规用药剂量,而暂可沿用阿奇霉素、环丙沙星、替加环素的常规用药剂量。目前对于抗真菌药物在ECMO期间药代动力学变化的研究较为有限,伏立康唑因其高亲脂性被ECMO大量吸附,建议使用更高剂量;米卡芬净在儿童ECMO患者中需要增加剂量;而卡泊芬净和氟康唑目前研究有限,尚不明确是否需要常规调整剂量。

Effect of extracorporeal membrane oxygenation on pharmacokinetics of antimicrobial drugs: recent progress and recommendations

Extracorporeal membrane oxygenation (ECMO) is an effective means to provide life support for patients with severe respiratory or heart failure. Existing studies have shown that ECMO may affect the metabolic process of some drugs by drug adsorption, increasing the apparent distribution volume and changing the clearance rate of the drugs. This review summarizes the recent progress in the studies of the effect of ECMO on the pharmacokinetics of antibacterial and antifungal drugs. For the antibacterial drugs, it is recommended that the dose of teicoplanin, imipenem, and linezolid should be increased during ECMO support, while the dose of azithromycin, ciprofloxacin, and tigecycline should not be modified for the time being. Currently studies on pharmacokinetic changes of antifungal drugs during ECMO support remain limited. Voriconazole can be absorbed substantially by ECMO due to its high lipophilicity, and higher doses are therefore recommended. The dose of micafungin also needs to be increased in children undergoing ECMO. However, current evidence concerning the dose of caspofungin and fluconazole are limited, and it is not clear whether the routine dose should be adjusted during ECMO support.