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
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王强

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R969.1

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Teicoplanin concentration in cerebrospinal fluid during intravenous infusion in patients following neurosurgery operation
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    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:

    ObjectiveTo understand teicoplanin concentration in cerebrospinal fluid (CSF) during intravenous infusion in patients following neurosurgery operation, and evaluate whether drug concentration can be increased if bloodbrain barrier was damaged, and effect of continuous pump of drug on drug concentration in CSF.MethodsThe postneurosurgical surgery patients with surgical site/ventricular drainage were enrolled in the study, patients were divided into routine administration group(a dose of teicoplanin of 400 mg/12 h was administered for 30 min) and continuous administration group (a dose of 400 mg teicoplanin was administered for 30 min followed by a continuous infusion of 200 mg/6 h). CSF specimens were collected at respective time points of administration, teicoplanin concentration in specimens was measured.ResultsFor routine administration group, drug concentration in CSF was(0.004±0.0123)mg/L immediately after teicoplanin was bumped, the peak concentration was (0.712±1.028)mg/L after 1hour bumping, then concentration decreased gradually, which were (0.254±0.222),(0.173±0.152), and (0.355±0.207)mg/L at 12,18, and 24 hours of bumping respectively. For continuous administration group, drug concentration in CSF was(0.017±0.020))mg/L immediately after teicoplanin was bumped, the peak concentration reached (0.587±0.255)mg/L after 4hour bumping, then concentration were (0.429±0.416),(0.325±0.254),(0.476±0.686),and (0.318±0.464)mg/L at 6,12,18, and 24 hours of bumping respectively, teicoplanin concentration was relatively stable 6 hours later, which were (0.318±0.464)mg/L(0.476±0.686)mg/L. The area under the curve during 24 hours (AUC024) in routine administration group and continuous administration group were 5.590 mg/ L·h and 9.082 mg/L·h respectively. For two groups of patients, teicoplanin concentration only at the area near peak value achieved 50% minimum inhibitory concentration(MIC50) for coagulase negative staphylococcus (CNS), but the time for achieving concentration higher than CNS MIC50 was far less than 50% of total administration time; teicoplanin concentration in CSF of both groups of patients didn’t achieve MIC50 for Staphylococcus aureus.ConclusionAfter continuous infusion of teicoplanin, drug concentration in CSF can be increased compared with routine administration group,but still can’t achieve the effective MIC; the increase of blood drug concentration is benefit to drug concentration in CSF, it is necessary to increase the dose appropriately to achieve clinical effectiveness.

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康建磊,武元星,于书卿,等.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[J]. 中国感染控制杂志,2015,14(12):798-802. DOI:10.3969/j. issn.1671-9638.2015.12.002.
KANG Jianlei, WU Yuanxing, YU Shuqing, et al. Teicoplanin concentration in cerebrospinal fluid during intravenous infusion in patients following neurosurgery operation[J]. Chin J Infect Control, 2015,14(12):798-802. DOI:10.3969/j. issn.1671-9638.2015.12.002.

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  • 收稿日期:2015-02-28
  • 最后修改日期:2015-07-12
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  • 在线发布日期: 2015-12-30
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