Planchock N Y, Slay L E
Crit Care Nurs Clin North Am. 1996 Mar;8(1):79-89.
The cases presented illustrate the clinical application of several of the common pharmacokinetic and pharmacodynamic changes in the elderly. The number of drugs that must be used with caution in the aging person is potentially quite large. In addition, there are numerous other diseases that can result in additional changes in drug absorption, distribution, metabolism, excretion, and target-organ effect. These conditions are particularly prevalent in the elderly patient in the critical care setting, and include the systemic inflammatory response syndrome, sepsis, acute renal failure, diabetic ketoacidosis, and the postoperative state. It must be emphasized, however, that the elderly are not a homogeneous group. The rate of decline of many physiologic functions varies widely. Chronic diseases and lifestyle alterations are additional variables that affect the function of many body systems. Furthermore, it is likely that the different pharmacokinetic and pharmacodynamic parameters discussed in this article do not all change to the same degree in a given individual. Pharmacologic therapy, therefore, always will be quite empiric in elderly patients. There is no substitute for meticulous monitoring of the patient using every available modality. This is particularly crucial in the critical care setting, where drugs can be lifesaving and life threatening at the same time.
所呈现的病例说明了老年人常见的几种药代动力学和药效学变化的临床应用。在老年人中必须谨慎使用的药物数量可能相当多。此外，还有许多其他疾病会导致药物吸收、分布、代谢、排泄及靶器官效应发生额外变化。这些情况在重症监护环境中的老年患者中尤为普遍，包括全身炎症反应综合征、脓毒症、急性肾衰竭、糖尿病酮症酸中毒及术后状态。然而，必须强调的是，老年人并非一个同质化群体。许多生理功能的衰退速度差异很大。慢性病和生活方式的改变是影响许多身体系统功能的额外变量。此外，本文讨论的不同药代动力学和药效学参数在特定个体中并非都以相同程度变化。因此，老年患者的药物治疗始终会相当依赖经验。没有什么能替代使用各种可用方式对患者进行细致监测。这在重症监护环境中尤为关键，因为药物在这种情况下可能同时具有救命和危及生命的作用。
