Hassan E, Ober J D
Department of Clinical Pharmacy, School of Pharmacy, University of Maryland, Baltimore 21201.
Antimicrob Agents Chemother. 1987 Nov;31(11):1855-8. doi: 10.1128/AAC.31.11.1855.
We conducted a prospective study to determine whether predicted aminoglycoside pharmacokinetic parameters (based on population averages) correlate with measured values in critically ill patients. There was wide interpatient variability for all pharmacokinetic parameters. Only predicted and measured volumes of distribution (18.7 +/- 6.5 versus 22.9 +/- 7.7 liters [mean +/- standard deviation], respectively), with a mean of 0.32 +/- 0.09 liter/kg of dosing body weight, were significantly different. There were no relationships between pharmacokinetic parameters and documented infection, death, or intubation status. The results indicate that volume of distribution is commonly underestimated in intensive care unit patients, whereas elimination rates may be adequately predicted based on population averages. We therefore recommend that aminoglycoside volume of distribution estimates for intensive care unit patients take fluid and adipose excess into account and be based on 0.32 liter/kg rather than the usual 0.25 liter/kg.
我们开展了一项前瞻性研究，以确定预测的氨基糖苷类药物药代动力学参数（基于总体均值）与重症患者的测量值是否相关。所有药代动力学参数在患者之间存在很大差异。只有预测的和测量的分布容积（分别为18.7±6.5与22.9±7.7升[均值±标准差]，按给药体重计算平均为0.32±0.09升/千克）有显著差异。药代动力学参数与记录的感染、死亡或插管状态之间无相关性。结果表明，重症监护病房患者的分布容积通常被低估，而消除率可基于总体均值得到充分预测。因此，我们建议，对重症监护病房患者氨基糖苷类药物分布容积的估计应考虑液体和脂肪过多的情况，并基于0.32升/千克而非通常的0.25升/千克。
