Connors J E, DiPiro J T, Sisley J F
University of Georgia College of Pharmacy, Athens.
Am J Surg. 1988 Jul;156(1):68-76. doi: 10.1016/s0002-9610(88)80176-4.
Surgical patients frequently require drug treatments that can be assessed with serum drug concentrations. Of the agents for which serum drug concentrations are routinely available, the aminoglycosides theophylline, vancomycin, digoxin, and phenytoin are used most frequently in surgical patients. When using serum drug concentrations, the clinician should have an understanding of the relationships (or lack of) between drug concentrations and therapeutic or toxic effects. When blood is collected for serum concentration determinations, the exact timing of the sample in relation to the dose must be considered. For some drugs, (such as the aminoglycosides, it is necessary to determine peak and trough concentrations, whereas for other agents, like theophylline, the average or mid-dose level may be more important to consider. There are many factors that affect serum drug concentrations. Among these are various disease states, obesity, fluid imbalances, the drug dosage form used, and concurrent drug use. Not all patients require serum drug concentration monitoring; however, with each drug there are high-risk patients who may benefit. When used properly, serum drug concentrations may be helpful in maximizing therapeutic benefits, minimizing or diagnosing drug toxicity, and assessing patient compliance with drug regimens.
外科患者经常需要进行可通过血清药物浓度评估的药物治疗。在常规可获得血清药物浓度的药物中，氨基糖苷类、茶碱、万古霉素、地高辛和苯妥英钠在外科患者中使用最为频繁。在使用血清药物浓度时，临床医生应了解药物浓度与治疗效果或毒性作用之间的关系（或缺乏这种关系）。在采集血液进行血清浓度测定时，必须考虑样本相对于给药剂量的确切时间。对于某些药物（如氨基糖苷类），需要测定峰浓度和谷浓度，而对于其他药物（如茶碱），考虑平均或中剂量水平可能更为重要。有许多因素会影响血清药物浓度。其中包括各种疾病状态、肥胖、液体平衡失调、所用药物剂型以及同时使用的其他药物。并非所有患者都需要进行血清药物浓度监测；然而，每种药物都有可能从中受益的高危患者。如果使用得当，血清药物浓度可能有助于最大限度地提高治疗效果、最小化或诊断药物毒性以及评估患者对药物治疗方案的依从性。
