本文選題：利奈唑胺 + 血藥濃度�。� 參考：《安徽醫(yī)科大學》2017年碩士論文

【摘要】：目的分析注射用利奈唑胺臨床應用合理性,對應用利奈唑胺注射劑治療感染的危重癥患者進行利奈唑胺血漿濃度的監(jiān)測,并分析影響血藥濃度的相關因素,為臨床更加安全有效的使用利奈唑胺提供參考。方法統(tǒng)計2015年1月到2016年11月使用利奈唑胺注射劑的臨床病歷,填寫《利奈唑胺臨床使用調(diào)查表》和《抗菌藥物合理應用評價標準表》,對不合理使用利奈唑胺注射劑的情況進行分析,并對影響治療效果和產(chǎn)生不良反應的因素進行研究。利用高效液相色譜法測定患者血漿中利奈唑胺的濃度,并分析肝、腎功能等因素對利奈唑胺血藥濃度的影響。結果共收集匯總128例臨床病歷信息,治療結束時細菌清除的患者共102例定義為治療有效組;細菌部分清除、未清除、菌群交替的患者共26例定義為治療無效組,細菌清除率最高的科室為呼吸內(nèi)科95.24%,最低的為腫瘤科64.29%,128份臨床病歷中合理用藥68例(53.13%)、基本合理34(26.56%)、不合理用藥26例(20.31%),兩組患者在用藥天數(shù)、肝功能、腎功能、發(fā)生不良反應方面存在顯著性差異。共20位患者發(fā)生藥品不良反應,其中11例發(fā)生血小板減少不良反應,無效組中發(fā)生不良反應的8例患者均出現(xiàn)肝、腎功能的異常。共監(jiān)測89例患者的血漿利奈唑胺濃度,肝、腎功能異常的患者與肝、腎功能正常的患者的利奈唑胺血漿濃度具有顯著性差異,且在腎功能異常組利奈唑胺血漿濃度個體差異較大,最高可達到8.70μg·ml-1,最低只有0.94μg·ml-1。共有9例患者出現(xiàn)利奈唑胺谷濃度小于2μg·ml-1最低抑菌濃度(minimal inhibitory concentration,MIC)的情況。結論本文建立的利奈唑胺檢測方法準確可靠,操作簡便,靈敏度高,可用于臨床利奈唑胺血藥濃度的檢測。利奈唑胺注射劑的使用主要存在無藥敏試驗用藥、用藥療程過短或過長、聯(lián)合用藥無指證等不合理現(xiàn)象。肝、腎功能異常的重癥感染患者利奈唑胺血漿濃度個體差異大,腎功能的影響主要作用于利奈唑胺的排泄方面,而肝功能的影響主要是由于重癥患者白蛋白水平的下降導致其血漿蛋白結合率的下降使總體的清除增加,最終使血藥濃度下降。在對利奈唑胺所致不良反應的分析中發(fā)現(xiàn)不良反應的發(fā)生與腎功能異常有關。綜合考慮以上因素才能為進一步規(guī)范利奈唑胺的合理使用和制定個性化給藥方案提供建議和參考。
[Abstract]:Objective to analyze the rationality of clinical application of linazolamide for injection, to monitor the plasma concentration of linazolidomide in critically ill patients with infection, and to analyze the related factors affecting the serum drug concentration. To provide a reference for the safe and effective use of linazolamide in clinical practice. Methods from January 2015 to November 2016, the clinical records of the patients treated with linazolamide injection were statistically analyzed. To fill out the questionnaire of clinical use of linazolamide and the evaluation standard of rational use of antimicrobial agents, to analyze the situation of improper use of linazolamide injection, and to study the factors affecting the therapeutic effect and adverse reactions. High performance liquid chromatography (HPLC) was used to determine the concentration of linazolamide in plasma, and the effects of liver and kidney function on the concentration of linazolamide in plasma were analyzed. Results A total of 128 clinical records were collected and collected. 102 patients with bacterial clearance at the end of the treatment were defined as the effective treatment group, and 26 patients who were partially cleared, not cleared, and alternately bacteria were defined as the ineffective treatment group. The department with the highest bacterial clearance rate was the Department of Respiratory Medicine 95.24m, the lowest was the Department of Oncology (64.29 / 128), the lowest was 68 cases of rational use of drugs (53.1313), the basic rational use of the drug was 3426.56%, the irrational use of the drug was 26 cases (20.31%), the days of medication, liver function, and renal function in the two groups. There were significant differences in adverse reactions. A total of 20 patients had adverse drug reactions, 11 of them had adverse effects of thrombocytopenia, 8 of the ineffective group had abnormal liver and renal function. There were significant differences in the plasma concentration of linazolamide between the patients with abnormal liver and kidney function and those with normal liver and renal function. In the renal dysfunction group, there was a significant difference in the plasma concentration of linazolamide, the highest was 8.70 渭 g ml-1, and the lowest was 0.94 渭 g ml-1. A total of 9 patients were found to have minimal inhibitory concentration of less than 2 渭 g ml-1. Conclusion the method established in this paper is accurate, reliable, simple and sensitive, and can be used to detect the serum concentration of lenazolidomide in clinic. The use of linazolamide injection is mainly caused by no drug sensitivity test, too short or too long course of treatment, no finger evidence and so on. In severe infection patients with abnormal liver and kidney function, the plasma concentration of linazolamide varies greatly. The effect of renal function is mainly related to the excretion of linazolamine. The effect of liver function was mainly due to the decrease of albumin level in severe patients, which resulted in the decrease of plasma protein binding rate and the increase of total clearance, and finally the decrease of serum drug concentration. In the analysis of adverse reactions caused by linazolamide, it was found that adverse reactions were related to abnormal renal function. Comprehensive consideration of the above factors can provide suggestions and references for further standardizing the rational use of linazolamide and for formulating individualized drug administration protocols.
【學位授予單位】：安徽醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R969

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