【摘要】 目的:建立同时测定重症加强护理病房（ICU）中耐碳青霉烯肠杆菌（CRE）感染患者替加环素及阿米卡星的血浆药物浓度的液相色谱-串联质谱（LC-MS/MS）方法，并将其应用于治疗药物监测（TDM）中。方法:血浆样品加入内标米诺环素及卡那霉素的甲醇溶液及氢氧化钠溶液，采用乙酸乙酯与二氯甲烷混合溶液提取，取上清液氮气吹干，加入甲醇复溶后进样分析。采用Waters Cortecs C₁₈（100 mm×4.6 mm, 2.7μm）色谱柱，流动相A为甲醇，流动相B为甲酸-甲酸铵水溶液，流速0.3 mL·min^-1,进样量2μL。检测以电喷雾离子源，正离子扫描，多反应监测模式进行。结果:替加环素及阿米卡星在ICU患者血浆中的线性范围及定量限均符合测定要求，批内、批间精密度、提取回收率、基质效应及稳定性均<15%。收集到10例同时接受替加环素（50 mg,每12 h服用1次）和阿米卡星（0.8 g,每天服用1次）治疗的CRE感染重症患者样本，2种药物血浆中稳态谷浓度分别为（88.45±98.97）ng·mL^-1及（2.98±1.59）μg·mL^-1,存在较大个体差异。结论:本方法快速、灵敏，专属性强且重复性好，可进行CRE感染的ICU患者临床TDM工作。更多还原

【Abstract】 Objective: To develop a method for simultaneous determination of the plasma drug concentrations of tegacyclin and amikacin in infection in intensive care unit（ICU） patients with carbapenem resistant enterobacteriaceae（CRE） using LC-MS/MS, and apply it to the therapeutic drug monitoring（TDM）. Methods: NaOH solution and methanol solution with internal standards of minocycline and kanamycin were added into plasma samples. The resulting solution was then extracted with the mixed solution of ethyl acetate and methylene chloride. The supernatant was dried with nitrogen and re-dissolved in methanol. Determination was carried out with a waters Cortec C₁₈（100 mm×4.6 mm, 2.7 μm） chromatographic column. Mobile phase A was methanol, mobile phase B was formic acid/ammonium formate aqueous solution, the flow rate was 0.3 mL·min^-1, and the injection volume was 2 μL. Electrospray spray ion source, positive ion scanning and multiple reaction monitoring mode were used. Results: The linear range and quantitative limit of tegacyclin and amikacin both met the requirements. The inter-and intra-day precision and matrix effect were all <15%. Samples of ten patients treated with tegacyclin（50 mg, q12h） and amikacin（0.8 g, qd） were collected. The steady-state trough concentrations of tegacyclin and amikacin in ten ICU patients with CRE infection were（83.86±84.56） ng·mL^-1 and（83.86±84.56） ng·mL^-1, respectively. There were large individual differences caused by the two antibiotics. Conclusion: This method is rapid, sensitive, specific and reproducible. It can be used for clinical TDM of ICU patients with CRE infection.更多还原