肾功能亢进在危重症患儿中的研究进展

Research advances in augmented renal clearance in critically ill children

摘要:

近年来，医学危重症领域提出了"肾功能亢进"（ARC）的概念，将其定义为肾脏对药物的清除能力增强，当肌酐清除率 > 130 mL/（min·1.73 m²）时，即认为患者存在ARC。越来越多的证据表明，ARC不仅存在于成人危重症患者，在危重症患儿中也普遍存在。危重症患儿可能因ARC造成的药物浓度不足导致治疗失败，但由于缺乏可靠的工具来评估危重症患儿的肾脏功能，ARC往往被忽视。因此，该文通过复习危重症患儿ARC的相关文献，对其概念、发生机制、影响因素、识别工具，以及对抗菌药物药代动力学/药效学及患儿临床结局的影响进行综述，旨在为临床用药提供参考。

Abstract:

In recent years, the concept of "augmented renal clearance" (ARC) has been proposed in the field of critical illness and is defined as enhanced renal clearance of drugs. ARC is considered when the creatinine clearance rate exceeds 130 mL/(min·1.73 m²). An increasing number of evidence has shown that ARC is commonly seen in critically ill adults and children. In critically ill children, low drug concentration due to ARC may lead to treatment failure. Unfortunately, ARC is often neglected due to the lack of reliable tools to assess renal function in critically ill children. Therefore, with reference to the articles on ARC in critically ill children, this article reviews the concept of ARC, the pathogenesis of ARC, the influencing factors for ARC, the identification tools for ARC, and the influence of ARC on pharmacokinetics/pharmacodynamics of antibacterial agents and clinical outcome, in order to provide a reference for clinical medication.