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JPKD群体药动学软件在万古霉素个体化给药中的应用及其研究

Study on Application of JPKD Population Pharmacokinetics Software in Individualized Administration of Vancomycin
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摘要 目的:评估万古霉素计算器(vancomycin calculator)及JPKD-vancomycin(万古霉素群体药动学软件,简称JPKD)在医院感染患者中万古霉素个体化给药中的临床应用。方法:收集2016年12月-2017年5月间医院临床收治的及接受药师会诊使用万古霉素的住院患者资料,排除其严重肾功能不全者(肌酐清除率小于30 mL/min),根据患者的一般资料(身高、体质量、年龄、血清白蛋白水平、有无水肿和液体复苏),设定并输入患者的个体参数,计算出患者万古霉素初始给药剂量,在应用万古霉素第4剂后第5剂前30 min,采集血样标本检测患者万古霉素血药浓度;如其血药浓度未达标,采用JPKD软件(采用贝叶斯剂量反馈法)输入患者的第1次万古霉素给药剂量及其相关的个体化信息,估算出患者个体的药动学参数,再输入万古霉素第2次预估给药剂量,每次给药间隔时间及输注时间,由软件依据上述参数估算出更改剂量后的万古霉素谷浓度,并通过临床病例实际测定结果予以验证。结果:所有以JPKD调整后估算的谷浓度为(12.8±5.9)μg/mL,经调整患者血药浓度后临床症状明显改善。结论:采用JPKD调整万古霉素血药浓度对临床合理使用万古霉素具有指导性意义,并有助于临床合理使用万古霉素。 Objective: To evaluate the clinical application of vancomycin calculator and JPKD-vancomycin(vancomycin population pharmacokinetics software JPKD) in the individualized administration of vancomycin in hospital infected patients. Methods: Data of hospitalized patients who were clinically admitted to the hospital and consulted by pharmacists for vancomycin were collected from December 2016 to May 2017. Ruling out the severe renal insufficiency(creatinine clearance is less than 30 mL/min), based on the patient’s general information(height, body mass, age, serum albumin level and presence of edema and liquid recovery), set and enter the patient’s individual parameters, calculate the vancomycin in patients with initial drug dosage;the application of vancomycin agent after 30 min before 5 agent, in 4 patients with blood samples was collected vancomycin blood drug concentration. As the blood drug concentration falls below, using JPKD software(using the bayesian dose feedback method) to enter the patient’s first vancomycin to drug dosage, and its related individual information to estimate the pharmacokinetic parameters of individual patients and second input vancomycin forecast to drug dosage, dosing interval and infusion time every time, after being changed by the software on the basis of the above parameters to estimate the dose concentration of vancomycin in the valley, and verified through clinical cases of actual measurement results. Results: All the estimated trough concentrations(12.8±5.9) g/mL were adjusted by JPKD, after which the clinical symptoms were significantly improved. Conclusion:Using JPKD to adjust the blood vancomycin concentration can guide the rational use of vancomycin in clinical practice, and it is helpful for the rational use of vancomycin in clinical practice.
作者 李璠 刘晓玲 LI Fan;LIU Xiaoling(Clinical Pharmacy, Xuzhou Central Hospital, Xuzhou Jiangsu 221009, China)
出处 《抗感染药学》 2019年第2期195-199,共5页 Anti-infection Pharmacy
基金 徐州市科技局计划项目(编号:XZZDY1605).
关键词 万古霉素 群体药动学 VANCOMYCIN CALCULATOR JPKD 个体化给药 vancomycin JPKD population pharmacokinetics vancomycin calculator individualized administration
作者简介 李璠(1984-),女,硕士,主管药师;通信作者:刘晓玲(1980-),女,副主任药师,联系电话,0516-85790126,E-mail:lxlxz828@126.com.
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