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我们如何利用药物浓度数据来改善过量患者的治疗效果?

How do we use drug concentration data to improve the treatment of overdose patients?

机构信息

Department of Clinical Toxicology and Pharmacology, University of Newcastle, New South Wales, Australia.

出版信息

Ther Drug Monit. 2010 Jun;32(3):300-4. doi: 10.1097/FTD.0b013e3181dca280.

Abstract

The role of drug assays for screening, diagnosis, and guiding treatment decisions in overdose patients remains unclear. The use of drug concentration data in clinical toxicology research is more problematic, with studies using drug concentrations to simply confirm ingestion in observational studies or others report drug concentration time profiles with simplified pharmacokinetics. The reasons for the lack of more substantial pharmacokinetic and/or pharmacodynamic analysis in overdose patients include problems with uncertainty in dose, uncertainty in the time of ingestion, and limited sampling in the absorption phase. Many of these can be overcome by using population pharmacokinetic and pharmacokinetic-pharmacodynamic analysis in prospective studies of overdose patients to understand dose-concentration-effect relationships. Uncertainty in dose and dose time can be included using population analysis techniques, which may involve a clinical assessment of the veracity of the patient history. The pharmacokinetic-pharmacodynamic model can then be used as the basis for predicting toxicity and clinical outcomes from historical information such as dose and early clinical effects. Using such an approach means that the use of drug concentration data in research will improve the risk assessment in overdose patients, without requiring these assays to be rapidly available in the acute health setting.

摘要

药物检测在筛选、诊断和指导过量患者治疗决策中的作用仍不清楚。在临床毒理学研究中使用药物浓度数据的问题更加突出,有些研究只是使用药物浓度来简单地确认观察性研究中的摄入,而其他研究则报告药物浓度时间曲线和简化的药代动力学。在过量患者中缺乏更实质性的药代动力学和/或药效学分析的原因包括剂量不确定性、摄入时间不确定性和吸收阶段采样有限。通过在过量患者的前瞻性研究中使用群体药代动力学和药代动力学-药效学分析,可以克服这些问题,以了解剂量-浓度-效应关系。可以使用群体分析技术来包含剂量和剂量时间的不确定性,这可能涉及对患者病史真实性的临床评估。然后,可以将药代动力学-药效学模型用作从剂量和早期临床效应等历史信息预测毒性和临床结果的基础。采用这种方法意味着,在研究中使用药物浓度数据将提高过量患者的风险评估,而无需在急性健康环境中快速获得这些检测。

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