肾衰竭中的计算机化药物剂量计算：一个实际问题及切实可行的解决方案。

Computerized drug dosing in renal failure: a real problem and a practical solution.

作者信息

Greenburg A G, Adachi W, McClure D K, Lawhead R A, Peskin G W

出版信息

J Trauma. 1978 May;18(5):308-16. doi: 10.1097/00005373-197805000-00003.

DOI:10.1097/00005373-197805000-00003

Abstract

In the presence of impaired renal function a number of pharmacologic agents require dose adjustments to avoid toxicity. Physician dose variations of a wide range of pharmaceuticals, 237 orders for 30 drugs for 107 patients, were compared to doses recommended by a computer program which considers renal function in calculating its dose. Disagreement in dose regimens was evaluated by comparison of physician-dose to computer-dose for three classes of drugs: wide range, narrow range, and 80% renally excreted. With true renal impairment (serum creatinine greater than or equal to 1.2 mg/100 ml and creatinine clearance less than 80 ml/m) significant overdosing occurred for narrow range and 80% renally-excreted agents, 83 and 77% respectively. There is a great potential hazard observed to be avoided. It is recommended that dose adjustments for nephrotoxic or renally-excreted agents be implemented using creatinine clearance (estimated or measured) with, at the very least, manufacturer's recommendations.

摘要

在肾功能受损的情况下，许多药物需要调整剂量以避免毒性。将107例患者使用的30种药物的237份医嘱中医生的剂量变化，与一个在计算剂量时考虑肾功能的计算机程序推荐的剂量进行了比较。通过比较三类药物（宽治疗窗药物、窄治疗窗药物和80%经肾排泄的药物）的医生剂量与计算机剂量，评估了剂量方案的差异。在真正的肾功能损害（血清肌酐大于或等于1.2mg/100ml且肌酐清除率小于80ml/min）情况下，窄治疗窗药物和80%经肾排泄的药物分别有83%和77%出现明显的过量用药。观察到有很大的潜在风险需要避免。建议至少根据制造商的建议，使用（估算或测量的）肌酐清除率对肾毒性或经肾排泄的药物进行剂量调整。