Droege Christopher A, Ernst Neil E
1 UC Health - University of Cincinnati Medical Center Department of Pharmacy Services, Cincinnati, Ohio.
2 University of Cincinnati James L. Winkle College of Pharmacy, Cincinnati, Ohio.
Ann Pharmacother. 2017 Jul;51(7):614-616. doi: 10.1177/1060028017694376. Epub 2017 Feb 16.
Obesity presents a growing challenge in critically ill patients because of variable medication pharmacokinetics and pharmacodynamics. Vasopressors used in the treatment of septic shock, including norepinephrine, are dosed using weight-based (WB) or non-weight-based (NWB) strategies. Retrospective research has evaluated the effect of total body weight and body mass index on vasopressor requirements, consequently finding that obese patients require less total vasopressor per kilogram to obtain clinical end points such as mean arterial pressure. Although this effect is not completely understood, this may suggest that a NWB dosing strategy is preferred over a WB strategy in obese patients to minimize potential for error.
由于药物的药代动力学和药效学存在差异，肥胖给重症患者带来了日益严峻的挑战。用于治疗感染性休克的血管升压药，包括去甲肾上腺素，采用基于体重（WB）或非基于体重（NWB）的策略给药。回顾性研究评估了总体重和体重指数对血管升压药需求量的影响，结果发现肥胖患者每千克体重所需的血管升压药总量较少，就能达到诸如平均动脉压等临床终点。尽管这种效应尚未完全明确，但这可能表明，在肥胖患者中，NWB给药策略优于WB策略，以尽量减少潜在误差。
