目的 分析體外膜肺氧合（ECMO）時抗感染治療藥物監(jiān)護(hù)的重點和難點。方法 回顧性分析28例使用體外膜肺氧合治療的危重癥患者，統(tǒng)計患者的臨床基本情況、病原學(xué)檢出、抗感染藥物使用和治療藥物監(jiān)測情況。結(jié)果 28例患者中男性20例，女性8例，平均年齡為44.7歲，平均ECMO持續(xù)時間20.3 d，使用ECMO前即有肝功能不全者16例、腎功能不全5例、心衰7例、低蛋白血癥18例，12例合并使用持續(xù)腎臟替代治療（CRRT），平均APACHEII評分為19.1分，SOFA評分為7.6分。ECMO撤離后最終治療成功、存活患者7例，死亡、自動出院或放棄治療21例。共培養(yǎng)出病原體55例，多數(shù)為多重耐藥革蘭陰性桿菌、碳青霉烯類藥物耐藥，治療藥物監(jiān)測為萬古霉素19例、碳青霉烯類11例、伏立康唑4例，血藥濃度監(jiān)測各品種均有超過半數(shù)未在治療范圍內(nèi)。結(jié)論 ECMO影響危重患者的血藥濃度，應(yīng)加強(qiáng)對該類患者的抗感染治療藥學(xué)監(jiān)護(hù)。

Objective The emphases and difficulties of anti-infective drug monitoring in extracorporeal membrane oxygenation (ECMO) were analyzed. Methods A retrospective analysis of 28 critically ill patients treated with ECMO was performed. The clinical characteristics, pathogen detection, anti-infective agent's application, and therapeutic drug monitoring were statistically analyzed. Results Of the 28 patients, 20 were male and 8 were female, with an average age of 44.7 years. The mean ECMO duration was 20.3 d. There were 16 patients with hepatic insufficiency, 5 patients with renal insufficiency, and 7 patients with heart failure, 18 cases of hypoproteinemia before ECMO. And there were 12 cases combined with CRRT; the average APACHE II score was 19.1 and SOFA score was 7.6. The overall outcomes were 7 patients survived, and 21 patients died or discharged automatically or abandoning therapy. A total of 55 pathogens were collected, most of which were multi-drug resistant Gram-negative bacilli and carbapenem-resistant. The therapeutic drugs application were vancomycin 19, carbapenems 11, voriconazole 4, etc. More than half of the TDM were not in the treatment range. Conclusion ECMO affects the blood concentration of anti-infective agents in critically ill patients and pharmaceutical care need to be strengthened.

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