Jones T E, Peter J V, Field J
Intensive Care Unit, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia.
Anaesth Intensive Care. 2009 Nov;37(6):944-52. doi: 10.1177/0310057X0903700611.
The aim of this study was to determine whether creatinine clearance can be estimated as well by clearance of gentamicin/tobramycin as by routine, non-invasive estimates in the intensive care unit. The volume of distribution and clearance values for gentamicin/tobramycin were obtained using first order kinetics and an estimate of creatinine clearance derived. Seven estimates of renal function (Cockroft-Gault, MDRD4 and MDRD6 equations, two- and 24-hour urine estimates, two equations utilising Cystatin C concentrations) were compared to the gentamicin/tobramycin clearance estimate in 100 intensive care unit patients. The gentamicin clearance estimate was at least as reliable as other estimates. The two-hour was less reliable than the 24-hour urine estimate. The Cockroft-Gault appeared to out-perform the MDRD equation estimates. The MDRD4 was not as reliable as the MDRD6 estimate. Cystatin C estimates appeared not as reliable as the gentamicin estimate of renal function. The gentamicin/tobramycin estimate is at least as good as other estimates and it is available sooner than most others. It should be used in all patients who are prescribed gentamicin. The two-hour urine and MDRD4 estimates should not be used in the intensive care unit.
本研究的目的是确定在重症监护病房中，庆大霉素/妥布霉素清除率对肌酐清除率的估算效果是否与常规非侵入性估算方法一样好。使用一级动力学方法获取庆大霉素/妥布霉素的分布容积和清除率值，并得出肌酐清除率的估算值。在100例重症监护病房患者中，将七种肾功能估算方法（Cockroft-Gault公式、MDRD4和MDRD6方程、两小时和24小时尿估算方法、两种利用胱抑素C浓度的方程）与庆大霉素/妥布霉素清除率估算值进行了比较。庆大霉素清除率估算值至少与其他估算方法一样可靠。两小时尿估算方法不如24小时尿估算方法可靠。Cockroft-Gault公式似乎比MDRD方程估算方法表现更好。MDRD4不如MDRD6估算方法可靠。胱抑素C估算方法似乎不如庆大霉素对肾功能的估算方法可靠。庆大霉素/妥布霉素估算方法至少与其他估算方法一样好，而且比大多数其他方法能更快得出结果。所有使用庆大霉素的患者都应采用该方法。两小时尿估算方法和MDRD4估算方法不应在重症监护病房中使用。
