CLEARANCE OF CEFTRIAXONE IN CRITICAL CARE PATIENTS WITH ACUTE-RENAL-FAILURE
CLEARANCE OF CEFTRIAXONE IN CRITICAL CARE PATIENTS WITH ACUTE-RENAL-FAILURE
复制标题
DOI：
10.1007/bf01711224
复制
发表时间：
1990-01-01
影响因子：
38.9
通讯作者：
ROOTS, I
中科院分区：
文献类型：
--
作者：
HEINEMEYER, G;LINK, J;ROOTS, I
监测了5名患有急性肾衰竭（ARF）的手术重症监护患者的第三代头孢菌素--头孢三嗪（罗思芬）的血清浓度，并与7名无肾功能障碍的患者进行了比较。在7天的时间内，通过15分钟输注给予2 g/天的固定剂量。通过拟合治疗期间测量的所有血清和尿液数据计算药代动力学参数。在第2天和第7天测量头孢曲松游离分数。在观察期间，没有证据表明头孢曲松清除率存在个体内变化。头孢曲松肾清除率与肌酐清除率的线性回归方程为Clren = 0.14 Clcrea + 2.2（r = 0.951）。p < 0.0001）。总清除率也与肌酐清除率相关：Cltot = 0.19 Clcrea + 8.2（r = 0.964，p < 0.0001）。与游离分数相关，肾清除率在肾小球滤过率范围内。当与游离分数相关时，非肾清除率显著降低，表明急性肾衰竭患者的胆汁排泄也受损。显然，肝头孢曲松清除率没有代偿性增加。结论：外科重症监护患者急性肾功能衰竭时，头孢曲松的消除可能受到严重损害，应根据肌酐清除率受损程度限制剂量。
Serum concentrations of ceftriazone (Rocephin), a third generation cephalosporin, were monitored in 5 operative intensive care patients suffering from acute renal failure (ARF) and compared to those of 7 patients without renal disturbance. For a period of 7 days, a fixed dose of 2 g/day was given by a 15 min infusion. Pharmacokinetic parameters were calculated by fitting all serum and urine data measured over the period of treatment. Ceftriaxone free fraction was measured on days 2 and 7. There was no evidence for an intraindividual change in ceftriaxone-clearance during the observation period. Ceftriaxone renal clearance was closely dependent on creatinine clearance according to a linear regression expressed by Clren = 0.14 Clcrea + 2.2 (r = 0.951. p < 0.0001). Total clearance was also associated with creatinine clearance: Cltot = 0.19 Clcrea + 8.2 (r = 0.964, p < 0.0001). Related to the free fraction, renal clearance was in the range of the glomerular filtration rate. Non-renal clearance was strongly decreased when related to the free fraction indicating that biliary excretion is also impaired in patients with acute renal failure. Obviously no compensatory increase in hepatic ceftriaxone clearance takes place. It is concluded that elimination of ceftriaxone may be strongly impaired during acute renal failure in surgical intensive care patients and that dosage should be restricted according to degree of the impairment of creatinine clearance.