摘要
目的研究老年慢性阻塞性肺部疾病(COPD)患者奈替米星(NTM)静脉滴注给药在下呼吸道的分布和药物动力学,并分析其临床疗效和不良反应。方法 24例COPD患者分为A、B组,每组12例。2组NTM剂量分别为A组每天7.0 mg/kg,B组给予5.0 mg/kg,静脉滴注。利用荧光偏振免疫方法,使用尿素替代肺泡液稀释内标,测定肺泡液、支气管分泌液和血清中的NTM浓度。结果 A组药物动力学参数表现为,血清中NTM最高浓度Cmax可达(26.73±4.96)mg/L,消除半衰期为3.95 h;肺泡液中最高浓度为(7.75±2.12)mg/L,是血清Cmax的30%,而支气管分泌液中药物的浓度与肺泡液浓度呈正相关(r=0.6434,P<0.05)。采用静脉滴注给药方式,肺泡中的药物浓度比常见肺炎致病菌的MIC值高。连续给药7 d后,所有患者均未见神经、肝、肾毒性。结论静脉滴注给药方式,给药间隔时间长,且不会增加不良反应,更适用于临床上老年COPD患者的治疗。
Objective To investigate the distribution and pharmacokinetics of ） netilmicin （ NTM ） in lower respiratory tract of elderly patients with chronic obstructive pulmonary disease （ COPD ） by means of intravenously guttae administration （ iv gtt） ,and to analyze its therapeutic effect and adverse reactions.Methods The concentrations of NTM in bronchial secretions,pulmonary alveolus solution and serum were detected by fluorescence polarization immunoassay （ FPIA） , using urea as diluted internal standard instead of pulmonary alveolus solution.Results The pharmacokinetic parameters in patents who received intravenously guttae with netilmicin 7.0mg/kg were as follows： the maximum concentration （ Cmax） of NTM was （26.73 ±4.96）mg/L,elimination half life was 3.95h,the maximum concentration of NTM in pulmonary alveolus solution was （7.75 ±2.12） mg/L,which was equal to 30%of serum Cmax.However there was no correlation between the drug concentration in bronchial secretions and blood drug level.The drug concentration in pulmonary alveoli was higher than MIC value of common pathogen of pneumonia by means of intravenously guttae administration.The toxicities of nerve, liver and kidney were not found in all the patients after successive administration for 7 days.Conclusion The intravenously guttae way is more suitable for the treatment of COPD in elderly patients,with longer dosing interval,without increasing side effects.
出处
《河北医药》
CAS
2015年第8期1148-1151,共4页
Hebei Medical Journal
基金
广东省医学科学技术研究基金项目(编号:wsTJJ20131227422827196210240020)
关键词
静脉给药
奈替米星
肺疾病
阻塞性
临床效果
药动学
intravenously guttae administration
netilmicin
pulmonary disease,obstructive
clinical effect
pharmacokinetic
