万古霉素在持续性静-静脉血液滤过时的药代动力学研究

目的：研究持续性静-静脉血液滤过（CVVH）时万古霉素的药代动力学特点，指导临床合理用药。方法：应用荧光偏振免疫分析仪测定万古霉素应用不同阶段的血药浓度，计算其药代动力学参数。结果：万古霉素在该患者体内的药代动力学符合开放型二室模型。用药3d主要药代参数：峰浓度（Cmax)=22.18mg/l，谷浓度（Cmin)=5.82mg/L，半衰期（T1/2）=5.75h，总体分布容积（Vd)=21.92,L,总体清除率（CL）=3.49L/h。用药16d主要药代参数；Cmax=38.70mg/L,Cmin=16.50mg/L,T1/2=33.32h,Vd=12.92L,CL=0.38L/h。结论：CVVH可以清除万古霉素，用药时应考虑多种影响因素，并监测血药浓度以提高疗效，减少药物对肾脏的损伤。

Phamacokinetics of vancomycin in continuous veno-venous hemofiltration

Objective:To investigate the phamacokinetics of vancomycin in continuous venovenous hemofiltration(CVVH) in order to determine appropriate vancomycin dosing strategies for patients receiving CVVH . Methods: The serum concentrations of vancomycin were measured by TDx and the pharmacokinetics parameters were calculated.Results:The pharmacokinetics of vancomycin during CVVH was fitted with open twocompartment model.At the beginning of CVVH,the pharmacokinetic parameters were:maximum plasma concentration (Cmax)=22 18 mg/L,minimum plasma concentration attained(Cmin)=5 82 mg/L,halflife of drug(T1/2)=5 75 h,apparent volume of distribution(Vd)=21 92 L,total body clearance of drug(CL)=3 49 L/h?On the 16 d of CVVH,the pharmacokinetic parameters were Cmax=38 70 mg/L,Cmin= 16 50 mg/L ,T1/2=33 32 h,Vd=12 92 L,CL=0 38 L/h. Conclusion:CVVH can significantly augment the clearance of vancomycin in acute renal failure patients.Dosing strategies for individualization of vancomycin therapy in patients receiving CVVH are proposed.Monitoring the serum concentration during CVVH is necessary.