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连续性肾替代治疗(CRRT)是近年来危重医学治疗中重要的进展之一,常用于治疗肾功能衰竭、非肾功能衰竭的危重疾病。急性肾功能衰竭危重患者大多有严重感染而需要应用抗感染药物。然而,接受CRRT的危重患者药物清除率常变化不定,从而使许多抗感染药物不能达到或维持其有效治疗血浓度,导致疗效降低以及耐药菌的产生。影响抗感染药物作用的因素包括CRRT的机械因素和药物因素;药物因素有:蛋白结合率、代谢途经、分子质量、表观分布容积、分子电荷。因此,使用CRRT时,应进行血药浓度监测并根据监测结果调整抗感染药物的剂量,以达到预期的治疗效果。
Continuous renal replacement therapy (CRRT) is one of the most important progresses in critically ill medical treatment in recent years. It is commonly used in the treatment of critically ill patients with renal failure and non-renal failure. Most critically ill patients with acute renal failure have severe infections that require the use of anti-infectives. However, drug clearance in critically ill patients receiving CRRT is often variable, preventing many anti-infectives from achieving or maintaining their effective therapeutic blood concentration, resulting in diminished efficacy and resistant bacteria. The factors affecting the anti-infective drug effects include the mechanical factors and drug factors of CRRT; drug factors are: protein binding rate, metabolic pathway, molecular mass, apparent volume of distribution, molecular charge. Therefore, the use of CRRT, blood concentration should be monitored and adjusted according to the monitoring of anti-infective drug dose, in order to achieve the desired therapeutic effect.