Study On Vancomycin Pharmacokinetics In Critically Ill Patients Received Or Not Received CRRT

Object:Analyze and compare the pharmacokinetics characteristics changes of Vancomycin on critical ill patients received or not received CRRT, and find out the influence factors. This can be used as a reference for the critical ill patients treatment.Methods:Two groups were chosen from the ICU patients with renal dysfunction,which received Vancomycin therapy in Shandong Qilu Hospital(2010.3-2011.11), CRRT group and the control group, on the basic of CRRT.. Patients’plasma samples were collected after administration and analyzed by FPIA method using Abbott AxSYM Vancomycin_II system. Pharmacokinetic parameters were calculated by DAS2.0processing and analyzed by PASW v20.0statistical analysis software package.Results:Dividing equally16ICU patients into2groups, CRRT group (Aqurius balance system, Baxter HF1200filter,7CVVH models,1CVVHD model, VPV150-180ml/min,displacement liquid1000-1500ml/h) and the control group. The control group received the same conventional therapy as the CRRT group exclude the CRRT therapy. The phannacokinetic process of critical ill patients is following a two compartments model. The pharmacokinetics parameters in the CRRT group are as follows:t1/2α=0.31h,Vd=0.26L/kg,t1/2β=13.82h,CL=0.067L/min,AUC0-x=477.79(mg/L)· h, Cmax=43.34mg/L, Cmin=14.97mg/L. Compared with the control group, there is a quicker distribution phase (t1<2a0.31h vs.0.57h, P=0.069) but a shorter elimination half-time(13.82h vs.36.97h, P=0.002), and the distribution volume is no evident difference. The peak valley of therapeutic is within control. In the control group, the pharmacokinetic parameters are correlated with patients’renal creatinine clearance (CLCR)(r=0.8, P<0.05), SOFA score (r=0.76, P<0.05), and plasma albumin(r=0.902, P<0.01).Conclusion:CRRT can increase the distribution and clearance rate of vancomycin, by means of adding dosage to take a target concentration. The apparent CLCR should be used to guide the vancomycin dosage regiment for CRRT patients. Pharmacokinetic parameters of ICU patients with renal dysfunction are mainly influenced by renal function, age, weight, plasma albumin, APACHE score and SOFA score. CLCR should be employed as a predictor for dosage and TDM.