神经外科术后患者静脉输注去甲万古霉素后血清及脑脊液药物浓度

发布时间：2018-02-16 06:55

本文关键词： 去甲万古霉素持续给药血清药物浓度脑脊液药物浓度药物代谢动力学/药效动力学　出处：《中国感染控制杂志》2017年05期 　论文类型：期刊论文

【摘要】：目的了解神经外科术后患者静脉输注去甲万古霉素后血清及脑脊液内药物浓度变化特点。方法选择2014年某院神经外科手术后留置术区/脑室引流管的患者,按给药方式不同分为2组,各12例,常规给药组:去甲万古霉素0.8 g,泵入60 min,12 h重复给药;持续给药组:去甲万古霉素0.8 g,泵入60 min,再0.4 g泵入11 h,后以0.4 g持续泵入12 h,于给药后不同时间点采集患者血清和脑脊液标本,测定去甲万古霉素浓度。结果常规给药组与持续给药组去甲万古霉素血清峰浓度分别为(55.52±26.04)、(59.22±41.88)mg/L,给药24 h血清浓度分别为(8.21±6.04)、(9.11±5.09)mg/L;脑脊液峰浓度分别为(16.31±11.15)、(8.82±8.91)mg/L,给药24 h脑脊液浓度分别为(6.12±2.34)、(5.71±4.72)mg/L。常规给药组药物脑脊液穿透率以药物浓度曲线下面积比计算(AUC_(脑脊液)/AUC_(血清))0~12 h为63.3%,12~24 h为59.0%;持续给药组0~12 h为25.4%,0~24 h为47.4%。以目标细菌MRSA95%的最低抑菌浓度(MIC_(90))为2 mg/L计算,常规给药组AUC_(0-24)/MIC_(90)为192,持续给药组AUC_(0-24)/MIC_(90)为184。结论神经外科术后患者早期使用标准剂量去甲万古霉素,常规及持续给药脑脊液内药物浓度均可达目标细菌的MIC_(90)。
[Abstract]:Objective to investigate the changes of drug concentration in serum and cerebrospinal fluid after intravenous infusion of norvancomycin after neurosurgery. They were divided into two groups according to different administration methods, 12 cases in each group. Routine administration group: norvancomycin 0.8 g, pumped into 60 mins for 12 h repeated administration; In the continuous administration group, norvancomycin 0.8 g was pumped into 60 min, 0.4 g was pumped into 11 h, then 0.4 g was continuously pumped for 12 h. The serum and cerebrospinal fluid (CSF) samples were collected at different time points after administration. Results the serum peak concentration of norvancomycin was 55.52 卤26.04 卤41.88 mg / L, the serum concentration of norvancomycin was 8.21 卤6.04 卤9.11 卤5.09 mg / L after 24 h administration, and the peak concentration of cerebrospinal fluid was 16.31 卤11.15 1 mg / L, 8.82 卤8.91 mg / L, respectively, after 24 hours of administration, the peak concentration of norvancomycin in routine administration group and continuous administration group was 55.52 卤26.04 mg / L, respectively. The cerebrospinal fluid penetration rate in the routine administration group was calculated as the area ratio under the drug concentration curve (CSF / AUC) (CSF / AUC = 63.3C = 59.0 / L), while in the continuous administration group (0.12 h = 25.4g / L, 47.4h). The minimum inhibitory concentration (MRSA 95%) of the target bacteria was calculated as the minimal inhibitory concentration (MRSA 95%) and the minimal inhibitory concentration (MSM) of the target bacteria was calculated as 2 mg/L. In the routine administration group, AUCX / MICM _ 90 was 1922, and in the continuous administration group, AUCN _ (0-24) / MICM _ (90) was 184.Conclusion the standard dose of norvancomycin is used in the early stage of neurosurgery patients, and the drug concentration in the routine and continuous administration cerebrospinal fluid can reach the MICS9090 of the target bacteria.
【作者单位】：首都医科大学附属北京安贞医院;郑州大学附属肿瘤医院;首都医科大学附属北京天坛医院;中国医学科学院北京协和医学院北京协和医院;
【基金】：国家科技支撑计划基金资助项目(2012EP001004)
【分类号】：R969

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