胡莹,周柏村,林文静
HU Ying,ZHOU Baicun,LIN Wenjing

• 1:成都市第六人民医院药剂科

摘要(Abstract)：

目的应用蒙特卡罗模拟(MCS)优化ICU肾衰竭接受连续性静脉-静脉血液滤过(CVVH)治疗患者头孢哌酮舒巴坦钠抗鲍曼不动杆菌(AB)感染的给药方案。方法查阅头孢哌酮舒巴坦钠对AB的最低抑菌浓度(MIC)及其药动学资料,Crystal Ball软件模拟5 000例后得到f%T>MIC值及其概率分布,发现最佳给药方案。结果对于ICU肾功能正常患者,在3 g q8h,3 g q6h,6 g q8h及6g q6h给药方案下均无法达到满意的抗菌效果,f%T>MIC>40%的概率均小于90%;对于ICU肾衰竭接受CVVH治疗患者,在6 g q6h给药方案下有较好的治疗效果,f%T>MIC>40%的概率约90%。结论随着近年AB对头孢哌酮舒巴坦钠耐药率的增加,ICU肾功能正常患者使用常规剂量头孢哌酮舒巴坦钠已无法达到满意的抗菌效果,而在ICU接受CVVH治疗的肾衰竭患者仍可推荐使用6 g q6h的给药方案。
OBJECTIVE To optimize dosage regimens of cefoperazone sulbactam against Acinetobacter baumannii(AB) in ICU patients receiving continuous veno-venous hemofiltration(CVVH) using Monte Carlo simulation(MCS).METHODS The MIC for cefoperazone sulbactam against AB and the pharmacokinetic data of cefoperazone sulbactam in adult Chinese ICU patients receiving CVVH were collected.A 5 000-patient Monte Carlo simulation was conducted to estimate the probability of target attainment(PTA) by using Crystal Ball software.RESULTS The regimens of 3 g q8h,3 g q6h,6 g q8h and 6 g q6h of intravenous drip of cefoperazone sulbactam were not sufficient to achieve f%T>MIC>40% in ICU patients with normal renal functions,and the PTA were less than 90%.The regimen of 6 g q6h of intravenous drip of cefoperazone sulbactam was sufficient to achieve f % T>MIC>40% in ICU patients receiving CVVH,and the PTA was about 90%.CONCLUSION As the resistance rates of AB increased significantly in the past years,general dosage of cefoperazone sulbactam is not enough for ICU patients with normal renal functions.The recommended regimen of intravenous drip of cefoperazone sulbactam for adult Chinese ICU patients receiving CVVH is 6 g q6 h.

关键词(KeyWords)： 头孢哌酮舒巴坦钠;鲍曼不动杆菌;蒙特卡罗模拟;连续性静脉-静脉血液滤过
cefoperazone sulbactam;Acinetobacter baumannii;Monte Carlo simulation;continuous veno-venous hemofiltration

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 胡莹,周柏村,林文静
HU Ying,ZHOU Baicun,LIN Wenjing

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