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目前,尚无任何肝清除的内源性标记可用于指导调整给药剂量。为了预测药物在肝硬化病人中的动力学变化,可根据药物的肝提取度分类。肝高度提取药物,口服初始剂量应减量,维持剂量也必须修改;肝低度提取药物,只需降低维持剂量;对于肝中度提取药物,口服初始剂量应选正常人的低剂量,维持剂量则应当减量。尽管血清肌酐在正常水平,肝硬化病人经常有肾功能损害。然而,更重要的是要意识到采用推荐剂量仍然属于一般考虑,不能取代临床对肝病患者的密切监视。
At present, there are no endogenous markers of hepatic clearance that can be used to guide the dose adjustment. In order to predict the kinetics of drug changes in patients with cirrhosis, the drug can be classified according to the degree of liver extraction. Liver height extraction of drugs, oral initial dose should be reduced to maintain the dose must be modified; Liver low extraction of drugs, only to reduce the maintenance dose; for moderate liver extract drugs, oral initial dose should be selected normal low dose, maintenance dose It should be reduced. Although serum creatinine is at normal levels, patients with cirrhosis often have impaired renal function. However, it is more important to realize that the recommended dosage is still a general consideration and can not replace the clinical surveillance of patients with liver disease.