發(fā)布時(shí)間：2018-11-21 20:03

【摘要】：目的驗(yàn)證通過非線性混合效應(yīng)模型法(NONMEM)軟件建立的萬古霉素群體藥動學(xué)模型在神經(jīng)外科重癥患者中應(yīng)用的有效性和實(shí)用性。方法回顧性收集2013年3月—2014年3月南京鼓樓醫(yī)院神經(jīng)外科重癥加護(hù)病房中給予萬古霉素治療患者的性別、年齡、體重、血肌酐和血白蛋白數(shù)值,通過前期建立的群體藥動學(xué)模型,計(jì)算特定給藥劑量下萬古霉素的穩(wěn)態(tài)血藥谷濃度預(yù)測值,并與實(shí)際測量值比較,進(jìn)而統(tǒng)計(jì)學(xué)分析驗(yàn)證。結(jié)果共收集患者42例,測得萬古霉素血藥谷濃度53份,平均谷濃度為10.9 mg/L,范圍為1.6~49.1 mg/L。群體藥動學(xué)模型的預(yù)測值與實(shí)際測量值有顯著相關(guān)性(r=0.857,P0.001),平均絕對百分比誤差(MAPE)為0.407 9,預(yù)測值的95%置信區(qū)間為9.36~14.07,實(shí)測值的95%置信區(qū)間為8.92~14.32。結(jié)論該群體藥動學(xué)模型可以用于神經(jīng)外科重癥患者給予萬古霉素前的預(yù)測和藥物劑量的指導(dǎo)。但由于神經(jīng)外科危重癥患者昏迷,體重估計(jì)誤差較大(約30%),同時(shí)對比劑和利尿藥導(dǎo)致的腎功能改變影響結(jié)果。通過調(diào)整使用方法,預(yù)測準(zhǔn)確率提高到近70%。
[Abstract]:Objective to verify the effectiveness and practicability of vancomycin population pharmacokinetic model established by nonlinear mixed effect model method (NONMEM) in patients with severe neurosurgery. Methods Sex, age, body weight, serum creatinine and serum albumin were collected retrospectively from March 2013 to March 2014 in the intensive care unit of neurosurgery department of Nanjing Gulou Hospital. Based on the population pharmacokinetic model established in the early stage, the predicted values of vancomycin's steady-state blood drug concentration under specific dosage were calculated, and compared with the actual measured values, and then verified by statistical analysis. Results A total of 42 patients were collected and 53 samples of vancomycin were determined. The average concentration of vancomycin was in the range of 10.9 mg/L, 1.6 mg/L. and 49.1 mg/L., respectively. The predicted value of the population pharmacokinetic model was significantly correlated with the actual measured value (r = 0.857p 0.001). The average absolute percentage error (MAPE) was 0.407, and the 95% confidence interval of the predicted value was 9.36 鹵14.07. The 95% confidence interval of the measured value is 8.92 鹵14.32. Conclusion the pharmacokinetic model can be used to predict vancomycin and drug dosage in patients with severe neurosurgery. However, due to coma, weight estimation error was larger (about 30%) in critically ill patients in neurosurgery, and the effects of contrast agent and diuretic on renal function were also observed. By adjusting the use of the method, the accuracy of prediction is improved to nearly 70.
【作者單位】： 南京大學(xué)醫(yī)學(xué)院附屬鼓樓醫(yī)院神經(jīng)外科;南京大學(xué)醫(yī)學(xué)院附屬鼓樓醫(yī)院藥學(xué)部;
【基金】：南京市醫(yī)學(xué)科技發(fā)展資金 2012年南京市衛(wèi)生局“南京市衛(wèi)生青年人才培養(yǎng)工程”第二層次
【分類號】：R969

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