神经外科术后患者静脉输注替考拉宁脑脊液药物浓度研究

发布时间：2018-04-26 04:24

本文选题：替考拉宁 + 持续输注　；参考：《中国感染控制杂志》2015年12期

【摘要】：目的了解神经外科术后患者静脉输注替考拉宁时脑脊液药物浓度,探讨神经外科手术破坏血脑屏障后是否可增加脑脊液药物浓度,以及药物持续泵入对脑脊液药物浓度的影响。方法选择神经外科术后留置术区/脑室引流管的患者,分为常规给药组(替考拉宁400 mg,30 min泵入,1次/12 h重复给药)和持续给药组(替考拉宁400 mg,30 min泵入,再以200 mg,1次/6 h持续泵入),于给药后相应时间点采集脑脊液标本检测替考拉宁浓度。结果常规给药组脑脊液替考拉宁浓度泵入后即刻浓度为(0.004±0.0123)mg/L,泵入后1 h达峰值(0.712±1.028)mg/L,后逐渐下降,泵入后12、18、24 h分别为(0.254±0.222)、(0.173±0.152)、(0.355±0.207)mg/L。持续给药组脑脊液替考拉宁泵入后即刻浓度为(0.017±0.020)mg/L,4 h后达峰值(0.587±0.255)mg/L,泵入后6、12、18、24 h分别为(0.429±0.416)、(0.325±0.254)、(0.476±0.686)、(0.318±0.464)mg/L,6 h后药物浓度相对稳定,介于(0.318±0.464)~(0.476±0.686)mg/L。常规给药组、持续给药组的AUC0—24 h分别为5.590 mg/L·h、9.082 mg/L·h。两组患者仅峰值附近区域替考拉宁浓度达到凝固酶阴性葡萄球菌(CNS)MIC50,但其浓度高于CNS MIC50的时间占整个给药时间的比例远小于50%;两组患者脑脊液替考拉宁浓度均未能达到金黄色葡萄球菌MIC50。结论持续输注替考拉宁后,患者脑脊液药物浓度较常规给药组有所增加,但仍未能达所要求的MIC;结合血药浓度的实验,血液浓度增高有利于脑脊液药物浓度增加,可考虑适当增加剂量以达到临床治疗目的。
[Abstract]:Objective to investigate the concentration of cerebrospinal fluid (CSF) during teicoplanin infusion after neurosurgery, and to explore whether the concentration of cerebrospinal fluid (CSF) can be increased after neurosurgery breaking down the blood-brain barrier and the effect of continuous infusion of drug on CSF concentration. Methods the patients with intraventricular drainage tube were divided into routine administration group (teicoplanin 400 mg / min 30 min) and continuous administration group (teicoplanin 400 mg / min 30 min). At the same time, cerebrospinal fluid (CSF) samples were collected for teicoplanin concentration at the same time point after administration. Results in the routine administration group, the immediate concentration of teicoplanin was 0.004 卤0.0123 mg / L, the peak value was 0.712 卤1.028 mg / L at 1 hour after injection, and then decreased gradually, and it was 0.254 卤0.2220.173 卤0.152 mg / L at 24 h after injection, respectively. In the continuous administration group, the immediate concentration of teicoplanin was 0.017 卤0.020 mg / L and reached a peak value of 0.587 卤0.255 mg / L after 4 h, and the concentration of teicoplanin was 0.429 卤0.416 ~ 0.64 卤0.325 卤0.6846 ~ (mg / L) 0.318 卤0.464mg / L ~ (-1), 0.318 卤0.464mg / L ~ (-1), 0.318 卤0.464mg / L ~ 0.686mg / L, respectively. The AUC0-24 h of the routine administration group and the continuous administration group were 5.590 mg/L / h and 9.082 mg/L / h, respectively. The teicoplanin concentration near the peak value in both groups reached Coagulase-negative staphylococci MIC50, but the proportion of the time when the concentration was higher than CNS MIC50 was far less than that of the whole administration time, and the ticoplanin concentration of cerebrospinal fluid in both groups did not reach the same level. The results showed that MIC50 of Staphylococcus aureus. Conclusion after continuous infusion of teicoplanin, the concentration of cerebrospinal fluid in the patients was higher than that in the routine administration group, but it was still not up to the required MIC.The increase of blood concentration was beneficial to the increase of CSF drug concentration in combination with the experiment of blood concentration of teicoplanin. We may consider increasing the dosage appropriately to achieve the purpose of clinical treatment.
【作者单位】：郑州大学附属肿瘤医院;首都医科大学附属北京天坛医院;
【分类号】：R969.1

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