Analysis of therapeutic drug monitoring results for levetiracetam and its use in critically ill patients
王蓉蓉 1蔡乐 1李荣艳 1陈孟莉 1王天琳1
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作者信息
1. 解放军总医院医疗保障中心药剂科,北京 100853
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摘要
目的 分析左乙拉西坦治疗药物监测(therapeutic drug monitoring,TDM)结果,为重症患者临床合理用药提供参考.方法 收集2021年3月—2022年8月左乙拉西坦TDM数据和病历资料,分析左乙拉西坦治疗方案及谷浓度、峰浓度达标情况,探讨左乙拉西坦的血药浓度影响因素.结果 共收集64例次左乙拉西坦TDM数据,包括36例谷浓度和28例峰浓度,仅有36.1%患者的谷浓度达标.进行左乙拉西坦TDM的重症患者占52.8%,其中76.9%的重症患者存在肾功能亢进(augmented renal clearance,ARC)现象.1.5 每12 h 1次未达标组的重症患者可能存在更加严重的ARC.结论 左乙拉西坦的临床血药浓度达标率偏低.对于重症患者,应注意识别ARC,并根据TDM和肌酐清除率(creatinine clearance,Ccr)适当调整左乙拉西坦用药剂量.
Abstract
Objective To analyze the characteristics of levetiracetam TDM and provide references for the rational drug use in critically ill patients.Methods Blood concentration monitoring data and case data were collected from March 2021 to August 2022.The treatment plan of levetiracetam and the trough and peak concentrations were analyzed,the influencing factors of blood concentration were discussed.Results A total of 64 cases of levetiracetam TDM were collected,including 36 cases of trough concentration and 28 cases of peak concentration,and only 36.1%of the trough concentration reached the standard.52.8%of the patients were critically ill patients,and 76.9%of the critically ill patients had ARC.Critically ill patients may have more severe ARC in the 1.5 g q 12 h non-standard group.Conclusion In clinical practice,the blood concentration of levetiracetam has a low compliance rate.For critically ill patients,attention should be paid to identify ARC,and adjust the dosage according to TDM and Ccr individually.
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