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美罗培南在成人重症感染患者中的群体药动学研究进展
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| 篇名： | 美罗培南在成人重症感染患者中的群体药动学研究进展 |
| TITLE： | Advances in population pharmacokinetics of meropenem in critically ill adult patients |
| 摘要： | 美罗培南（MEM）是治疗重症感染的重要药物之一，但其标准剂量往往难以达到有效的治疗浓度目标。本文综述MEM在重症感染患者中群体药动学的相关研究，发现表观分布容（Vd）和清除率是影响其剂量调整的最主要因素。影响Vd的因素包括血清白蛋白、年龄、总体重、休克状态以及胸/腹/脑脊液引流等；影响清除率的因素主要为肾功能、肾脏替代治疗模式以及联合用药。针对中国成人重症感染患者，推荐MEM基于肾小球滤过率实施个体化给药，剂量为500～1500mg，q4h～q6h，并优先采用延长输注。当病原菌最低抑菌浓度（MIC）达到64mg/L时需进行治疗药物监测；疗效上应确保MEM谷浓度高于MIC，为避免耐药则应高于4倍MIC；安全性方面则建议谷浓度上限为32mg/L，采血时间可提前至给药1～2次后。 |
| ABSTRACT： | Meropenem （MEM） is one of the important drugs for the treatment of severe infections， but the standard dose is often difficult to achieve an effective therapeutic concentration target. This article reviews the related studies on the population pharmacokinetics of MEM in patients with severe infection. It is found that the apparent volume of distribution （Vd） and clearance rate are the most important factors affecting the dose adjustment， and the factors affecting Vd include serum albumin， age， overall weight， shock status， and chest/abdomen/cerebrospinal fluid drainage. The main factors affecting the clearance rate were renal function， renal replacement therapy treatment mode and combination therapy. For adult patients with severe infections in China， MEM is recommended to be administered in an individualized manner based on glomerular filtration rate， with a dosage range of 500 to 1 500 mg given every 4 to 6 hours， and prolonged infusion is preferred. When the minimum inhibitory concentration （MIC） of the pathogenic bacteria reaches 64 mg/L， therapeutic drug monitoring is required. For therapeutic efficacy， it is essential to ensure that the trough concentration remains above the MIC； to prevent drug resistance， it should be maintained above 4×MIC. Regarding safety， it is recommended that the upper limit of the trough concentration be 32 mg/L， and blood sampling for monitoring can be conducted as early as after 1 to 2 doses of administration. |
| 期刊： | 2025年第36卷第22期 |
| 作者： | 许贵琴；朵德龙；赵妮；常亚娥；桓芝兰；吴雪；王亚峰 |
| AUTHORS： | XU Guiqin，DUO Delong，ZHAO Ni，CHANG Ya’e，HUAN Zhilan，WU Xue，WANG Yafeng |
| 关键字： | 重症感染；美罗培南；群体药动学；给药方案 |
| KEYWORDS： | severe infection； meropenem； population pharmacokinetics； drug administration plan |
| 阅读数： | 8 次 |
| 本月下载数： | 0 次 |
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