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治疗药物监测(Therapeutic Drug Monitoring,简称TDM)是最近十年来临床治疗学中发展较为迅速领域之一。对于某些治疗剂量范围较窄的药物,通过对病人血液或其他体液中药物浓度的监测,随时掌握药物在体内的变化,可使临床用药更趋于合理化和个体化,借以避免或减少药物的不良反应,从而达到安全治疗的目的。 TDM的理论基础是临床药理学、药效学和药物动力学。通过血药浓度监测为确定给药方案、选择最佳剂量、时间间隔和预测药物的累积毒性提供依据。进行此项工作必须有灵敏和精确的监测方法,因为血液内药物浓度往往很低,一般化学方法不易测出。目前较多应用色谱法,但技术要求较高,需专人掌握,而免疫学方法测定血内药物浓度有现成试剂盒,一般临床实验室较易掌握,为普及推广TDM工作创造了条件。本文对免疫分析法中常用的放射免疫分析、酶免疫分析、荧光免疫分析等方法作了全面介绍,可供参考。TDM工作必须有临床药师、临床医师、临床药理医师、临床检验师等共同参加,密切配合及协作,才能推广开展,进一步提高临床药物治疗的水平。
Therapeutic Drug Monitoring (TDR) is one of the more rapidly developing areas of clinical therapeutics in the last decade. For some drugs with narrow therapeutic dose, the monitoring of drug concentration in blood or other bodily fluids of a patient can keep the changes of the drugs in the body and make the rationalization and individualization of clinical medicine more rational so as to avoid or reduce the drug Adverse reactions, so as to achieve the purpose of safe treatment. The theoretical basis of TDM is clinical pharmacology, pharmacodynamics and pharmacokinetics. Blood concentration monitoring to determine the dosing regimen, choose the best dose, time interval and predict the cumulative toxicity of drugs to provide the basis. This work must be sensitive and accurate monitoring methods, because the blood drug concentration is often low, the general chemical method is not easy to measure. Currently more applications of chromatography, but the higher technical requirements, need someone to master, and immunological methods for determination of intra-blood drug concentration ready-made kit, the general clinical laboratory easier to grasp, to promote universal TDM work to create the conditions. In this paper, immunoassay commonly used in radioimmunoassay, enzyme immunoassay, fluorescence immunoassay and other methods were fully described, for reference. TDM work must have clinical pharmacists, clinicians, clinical pharmacists, clinical examiners and other joint participation, close cooperation and collaboration in order to promote and further improve the level of clinical drug treatment.