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目的:对ICU肾衰竭接受连续性静脉-静脉血液滤过(continuous veno-venous haemofiltration,CVVH)治疗患者左氧氟沙星给药方案进行优化。方法:根据左氧氟沙星药效学及药动学参数等实验数据资料,应用蒙特卡洛模拟法计算累积反应分数(CFR),推荐最佳给药方案。结果:ICU肾衰竭接受CVVH治疗的患者,治疗肺炎克雷伯菌和肺炎链球菌感染时左氧氟沙星的最佳方案分别为500 mg qd iv和200 mg qd iv;ICU肾功能正常患者,对肺炎链球菌感染时左氧氟沙星的最佳方案为750 mg qd iv。对于肾衰竭或肾功能正常患者,当感染铜绿假单胞菌和金黄色葡萄球菌时,左氧氟沙星4种静注给药方案(200,300,500,750 mg qd)治疗效果均不佳,建议联合治疗或更换药物。结论:与ICU肾功能正常患者对比,ICU肾衰竭接受CVVH治疗患者使用左氧氟沙星时应根据不同病原菌感染考虑降低给药剂量。
OBJECTIVE: To optimize the regimen of levofloxacin in patients with ICU renal failure undergoing continuous veno-venous haemofiltration (CVVH). Methods: According to the experimental data of pharmacodynamics and pharmacokinetic parameters of levofloxacin, the cumulative reaction score (CFR) was calculated by Monte Carlo simulation and the best dosage regimen was recommended. RESULTS: The optimal regimen for levofloxacin in patients with ICU renal failure who received CVVH was 500 mg qd iv and 200 mg qd iv, respectively, for the treatment of Klebsiella pneumoniae and Streptococcus pneumoniae. In ICU patients with normal renal function, The best course of infection with levofloxacin is 750 mg qd iv. For patients with either renal failure or normal renal function, four intravenous regimens of levofloxacin (200, 300, 500 and 750 mg qd) did not respond well to treatment with Pseudomonas aeruginosa and Staphylococcus aureus, and combined treatment or drug replacement is recommended. CONCLUSIONS: In contrast to ICU patients with normal renal function, the dose of levofloxacin should be reduced according to different pathogen infections in ICU renal failure patients receiving CVVH.