切换至 "中华医学电子期刊资源库"

中华损伤与修复杂志(电子版) ›› 2023, Vol. 18 ›› Issue (03) : 260 -264. doi: 10.3877/cma.j.issn.1673-9450.2023.03.015

综述

危重烧伤患者肾功能亢进的药物治疗
刘晓彬, 朱峰()   
  1. 200433 上海,海军军医大学第一附属医院烧伤外科
  • 收稿日期:2023-03-27 出版日期:2023-06-01
  • 通信作者: 朱峰

Pharmacological treatments in critical burn patients with augmented renal clearance

Xiaobin Liu, Feng Zhu()   

  1. Department of Burn Surgery, the First Hospital Affiliated to Naval Medical University, Shanghai 200433, China
  • Received:2023-03-27 Published:2023-06-01
  • Corresponding author: Feng Zhu
引用本文:

刘晓彬, 朱峰. 危重烧伤患者肾功能亢进的药物治疗[J]. 中华损伤与修复杂志(电子版), 2023, 18(03): 260-264.

Xiaobin Liu, Feng Zhu. Pharmacological treatments in critical burn patients with augmented renal clearance[J]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2023, 18(03): 260-264.

肾功能亢进(augmented renal clearance, ARC)指患者肾脏清除功能显著增强,在危重症患者中较多见,危重烧伤患者中也常见,但易被忽视。过强的清除能力使得药物清除速度增加,在常规治疗剂量下无法达到目标血药浓度。危重烧伤患者发生ARC多在高代谢期,此时通过肾脏清除的药物血药浓度变化将对治疗效果产生严重影响。本文从ARC的定义、发生机制、危险因素以及发生危重烧伤合并ARC后对药物药代动力学和药效学(pharmacokinetics and pharmacodynamics,PK/PD)的评估和剂量调整等方面进行综述,旨在提高临床医生对重症烧伤患者发生ARC的认知程度并加以重视,为临床合理用药提供参考。

Augmented renal clearance (ARC) refers to significant enhancement of kidney clearance function, which is more common in critical patients and in critical burn patients, but it is often overlooked. ARC increases the clearance rate of drug, and the target blood concentration cannot be reached at conventional therapeutic doses. ARC occurs mostly at the high metabolic stage in critical burn patients while the decreased plasma concentration of drugs cleared by the kidney will affect the therapeutic effects seriously. The definition, pathogenesis, risk factors of ARC, and the evaluation of the pharmacokinetics and pharmacodynamics of related drugs and the dose adjustment methods after critical burn complicated with ARC are reviewed in this article, to improve the recognition of ARC in critical burns and to provide reference for rational drug use in clinical work.

[1]
Cook AM, Hatton-Kolpek J. Augmented Renal Clearance[J]. Pharmacotherapy201939(3):346-354.
[2]
Loirat P, Rohan J, Baillet A,et al. Increased glomerular filtration rate in patients with major burns and its effect on the pharmacokinetics of tobramycin[J].The New England Journal of Medicine, 1978299(17):915-919.
[3]
Carlier M, De Waele JJ. Identifying patients at risk for augmented renal clearance in the ICU - limitations and challenges[J]. Crit Care201317(2):130.
[4]
De Waele JJ, Dumoulin A, Janssen A,et al. Epidemiology of augmented renal clearance in mixed ICU patients[J]. Minerva Anestesiol201581(10):1079-1085.
[5]
Garrelts JC, Peterie JD. Altered vancomycin dose vs. serum concentration relationship in burn patients[J]. Clinical Pharmacology and Therapeutics, 198844(1):9-13.
[6]
Morbitzer KA, Jordan JD, Rhoney DH. Vancomycin pharmacokinetic parameters in patients with acute brain injury undergoing controlled normothermia, therapeutic hypothermia, or pentobarbital infusion[J]. Neurocrit Care, 201522(2):258-264.
[7]
Bilbao-Meseguer I, Rodríguez-Gascón A, Barrasa H, et al. Augmented renal clearance in critically ill patients: a systematic review[J]. Clin Pharmacokinet201857(9):1107-1121.
[8]
Udy AA, Roberts JA, Shorr AF,et al. Augmented renal clearance in septic and traumatized patients with normal plasma creatinine concentrations: Identifying at-risk patients[J]. Crit Care201317:R35.
[9]
Barletta JF, Mangram AJ, Byrne M,et al. Identifying augmented renal clearance in trauma patients: validation of the augmented renal clearance in trauma intensive care (arctic) scoring system[J]. J Trauma Acute Care Surg, 201782(4):665-671.
[10]
Udy AA, Baptista JP, Lim NL, et al. Augmented renal clearance in the ICU: results of a multicenter observational study of renal function in critically ill patients with normal plasma creatinine concentrations[J]. Crit Care Med, 2014, 42(3): 520-527.
[11]
杨柳,角述兰,思永玉,等.不同烧伤程度患者靶控输注丙泊酚的药代动力学[J].临床麻醉学杂志201834(8):777-781.
[12]
Huttner A, Von Dach E, Renzoni A, et al. Augmented renal clearance, low β-lactam concentrations and clinical outcomes in the critically ill: an observational prospective cohort study[J]. International Journal of Antimicrobial Agents, 201545(4):385-392.
[13]
Udy AA, Lipman J, Jarrett P, et al. Are standard doses of piperacillin sufficient for critically ill patients with augmented creatinine clearance?[J]. Crit Care201519(1):28.
[14]
Selig DJ, Akers KS, Chung KK, et al. Comparison of piperacillin and tazobactam pharmacokinetics in critically ill patients with trauma or with burn[J]. Antibiotics (Basel), 202211(5):618.
[15]
Torian SC, Wiktor AJ, Roper SE, et al. Burn injury and augmented renal clearance: a case for optimized piperacillin-tazobactam dosing[J]. J Burn Care Res202344(1):203-206.
[16]
Conil JM, Georges B, Fourcade O, et al. Intermittent administration of ceftazidime to burns patients: influence of glomerular filtration[J]. Int J Clin Pharmacol Ther200745(3):133-142.
[17]
Boucher BA, Hickerson WL, Kuhl DA, et al. Imipenem pharmacokinetics in patients with burns[J]. Clin Pharmacol Ther199048(2):130-137.
[18]
Selig DJ, Akers KS, Chung KK, et al. Meropenem pharmacokinetics in critically ill patients with or without burn treated with or without continuous veno-venous haemofiltration[J]. Br J Clin Pharmacol202288(5):2156-2168.
[19]
Bakke V, Sporsem H, Von der Lippe E, et al. Vancomycin levels are frequently subtherapeutic in critically ill patients: a prospective observational study[J]. Acta Anaesthesiol Scand, 201761(6):627-635.
[20]
Conil JM, Favarel H, Laguerre J, et al. Continuous administration of vancomycin in patients with severe burns[J]. Presse Med199423(34):1554-1558.
[21]
Abdul-Aziz MH, Alffenaar JC, Bassetti M, et al. Antimicrobial therapeutic drug monitoring in critically ill adult patients: a Position Paper[J]. Intensive Care Med202046(6):1127-1153.
[22]
Hu S, Wang T, You H, et al. Plasma trough concentration distribution and safety of high-dose teicoplanin for patients with augmented renal clearance[J]. J Clin Pharm Ther202247(10):1548-1555.
[23]
Steer JA, Papini RP, Wilson AP, et al. Pharmacokinetics of a single dose of teicoplanin in burn patients[J]. J Antimicrob Chemother199637(3):545-553.
[24]
Carrié C, Delzor F, Roure S, et al. Population pharmacokinetic study of the suitability of standard dosing regimens of amikacin in critically ill patients with open-abdomen and negative-pressure wound therapy[J]. Antimicrob Agents Chemother202064(4):e02098-02119.
[25]
Zaske DE, Sawchuk RJ, Gerding DN, et al. Increased dosage requirements of gentamicin in burn patients[J]. The Journal of Trauma, 197616(10):824-828.
[26]
Borra LC, Bosch TM, van Baar ME, et al. Adequacy of a hospital-wide standard dose of 7mg/kg bodyweight gentamicin sufficient to achieve an adequate prophylactic maximum serum concentration (cmax) in burn patients undergoing surgical burn wound treatment[J]. Burns, 201642(8):1819-1824.
[27]
Bracco D, Landry C, Dubois MJ, et al. Pharmacokinetic variability of extended interval tobramycin in burn patients[J]. Burns200834(6):791-796.
[28]
Hoey LL, Tschida SJ, Rotschafer JC, et al. Wide variation in single, daily-dose aminoglycoside pharmacokinetics in patients with burn injuries[J]. J Burn Care Rehabil. 199718(2):116-124.
[29]
Roberts JA, Cotta MO, Cojutti P, et al. Does critical illness change levofloxacin pharmacokinetics?[J]. Antimicrob Agents Chemother201560(3):1459-1463.
[30]
Kiser TH, Hoody DW, Obritsch MD, et al. Levofloxacin pharmacokinetics and pharmacodynamics in patients with severe burn injury[J]. Antimicrob Agents Chemother200650(6):1937-1945.
[31]
Lesne-Hulin A, Bourget P, Ravat F, et al. Clinical pharmacokinetics of ciprofloxacin in patients with major burns[J]. Eur J Clin Pharmacol199955(7):515-519.
[32]
Van Daele R, Wauters J, Lagrou K, et al. Pharmacokinetic variability and target attainment of fluconazole in critically ill patients[J]. Microorganisms20219(10):2068.
[33]
Han S, Kim J, Yim H, et al. Population pharmacokinetic analysis of fluconazole to predict therapeutic outcome in burn patients with candida infection[J]. Antimicrob Agents Chemother, 201357(2):1006-1011.
[34]
Akers KS, Rowan MP, Niece KL, et al. Antifungal wound penetration of amphotericin and voriconazole in combat-related injuries: case report[J]. BMC Infect Dis201515:184.
[35]
Asensio MJ, Sánchez M, Galván B, et al. Micafungin at a standard dosage of 100 mg/day achieves adequate plasma exposure in critically ill patients with severe burn injuries[J]. Intensive Care Med201541(2):371-372.
[36]
Trupkovic T, Kinn M, Kleinschmidt S. Analgesia and sedation in the intensive care of burn patients: results of a European survey[J]. Journal of Intensive Care Medicine, 201126(6):397-407.
[37]
Bae JY, Choi DY, Woo CH, et al. The BIS and hemodynamic changes in major burn patients according to a slow infusion of propofol for induction[J]. Korean Journal of Anesthesiology, 201160(3):161-166.
[38]
Martyn J, Greenblatt DJ. Lorazepam conjugation is unimpaired in burn trauma[J]. Clin Pharmacol Ther198843(3):250-255.
[39]
Perreault S, Choinière M, du Souich PB, et al. Pharmacokinetics of morphine and its glucuronidated metabolites in burn injuries[J]. The Annals of Pharmacotherapy, 200135(12):1588-1592.
[40]
Herman RA, Veng-Pedersen P, Miotto J, et al. Pharmacokinetics of morphine sulfate in patients with burns[J]. The Journal of Burn Care & Rehabilitation199415(2):95-103.
[41]
Dwersteg JF, Pavlin EG, Heimbach DM. Patients with burns are resistant to atracurium[J]. Anesthesiology, 198665(5):517-520.
[42]
Han TH, Martyn JA. Onset and effectiveness of rocuronium for rapid onset of paralysis in patients with major burns: priming or large bolus[J]. British Journal of Anaesthesia, 2009102(1):55-60.
[43]
Martyn JA, Chang Y, Goudsouzian NG, et al. Pharmacodynamics of mivacurium chloride in 13- to 18-yr-old adolescents with thermal injury[J].British Journal of Anaesthesia, 200289(4):580-585.
[44]
Cato LD, Bailiff B, Price J, et al. Heparin resistance in severe thermal injury: a prospective cohort study[J]. Burns Trauma. 20219:tkab032.
[45]
Lu P, Harms KA, Paul E, et al. Venous thromboembolism in burns patients: are we underestimating the risk and underdosing our prophylaxis?[J]. J Plast Reconstr Aesthet Surg, 202174(8):1814-1823.
[46]
Lin H, Faraklas I, Saffle J, et al. Enoxaparin dose adjustment is associated with low incidence of venous thromboembolic events in acute burn patients[J]. J Trauma, 201171(6):1557-1561.
[47]
Bilbao-Meseguer I, Barrasa H, Asín-Prieto E, et al. Population pharmacokinetics of levetiracetam and dosing evaluation in critically ill patients with normal or augmented renal function[J]. Pharmaceutics, 202113(10):1690.
[48]
Sime FB, Roberts JA, Jeffree RL, et al. Population pharmacokinetics of levetiracetam in patients with traumatic brain injury and subarachnoid hemorrhage exhibiting augmented renal clearance[J]. Clin Pharmacokinet202160(5):655-664.
[1] 周红玉, 李羽. 右美托咪定在儿童患者麻醉中的应用[J]. 中华妇幼临床医学杂志(电子版), 2021, 17(04): 482-487.
[2] 夏伟, 唐颖莹, 邢爱耘. 孕期新型抗癫痫药物的合理应用和研究进展[J]. 中华妇幼临床医学杂志(电子版), 2016, 12(01): 108-113.
[3] 王淑君, 鲁虹言, 杨林娜, 马春亭, 张博涵, 孙天骏, 申传安. 群组化即时通信管理在危重烧伤患者救治中的应用[J]. 中华损伤与修复杂志(电子版), 2022, 17(06): 507-512.
[4] 刘琰, 原博. 危重烧伤救治中一些关键问题的探讨[J]. 中华损伤与修复杂志(电子版), 2022, 17(06): 466-474.
[5] 石晓萍, 方洁, 王婷, 许青, 吕迁洲. 肝移植受者万古霉素治疗药物监测现状分析及群体药代动力学软件的临床验证[J]. 中华移植杂志(电子版), 2021, 15(01): 15-19.
[6] 杨丽莎, 刘畅, 胡健, 朱忠立, 徐伟, 祝国芸, 黎俊雅, 李福祥. 替考拉宁药代动力学指导重症G菌感染患者个体化用药的临床分析[J]. 中华肺部疾病杂志(电子版), 2019, 12(01): 53-58.
[7] 张睿, 石刚, 杨世华, 苏昊, 周思成, 裴炜, 梁建伟, 刘正, 关旭, 赵志勋, 刘骞, 周志祥, 王锡山, 张景, 周海涛. 洛铂用于结直肠癌术中腹腔灌注化疗的药代动力学研究[J]. 中华结直肠疾病电子杂志, 2020, 09(02): 144-149.
[8] 杨洁, 黄英姿. 重症感染患者病情严重程度对抗菌药物表观分布容积的影响[J]. 中华重症医学电子杂志, 2019, 05(03): 282-285.
[9] 朱熠冰, 席修明. 镇痛镇静药物在持续性肾脏替代治疗中的药代动力学[J]. 中华重症医学电子杂志, 2018, 04(01): 18-21.
[10] 王春耀, 翁利. 连续肾脏替代治疗时抗菌药物的剂量调整[J]. 中华重症医学电子杂志, 2017, 03(01): 60-64.
[11] 张涛, 王娟, 杨艳敏, 朱俊, 张晗, 邵兴慧. 肌酐清除率与中国急诊非瓣膜性心房颤动患者的预后研究[J]. 中华心脏与心律电子杂志, 2022, 10(04): 238-245.
阅读次数
全文


摘要