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)。
ObjectiveTo understand the changing characteristics of drug concentration in the serum and cerebrospinal fluid（CSF） after intravenous （IV） drip of norvancomycin in patients after neurosurgery procedure. MethodsPatients with surgical cavity/ventricular drainages after neurosurgery procedure in a hospital in 2014 were selected, and they were divided into 2 groups according to the administration modes （12 in each group）, conventional administration group： 0.8 g norvancomycin IV drip for 60 minutes, repeated every 12 hours; continuous administration group, 0.8 g norvancomycin, IV drip for 60 minutes, followed by 0.4 g of IV drip for 11 hours, then 0.4 g for 12 hours, serum and CSF specimens were collected at different time points after administration, concentration of norvancomycin was determined. ResultsSerum norvancomycin concentration reached a peak of （55.52±26.04） and （59.22±41.88） mg/L in conventional administration group and continuous administration group respectively, 24hour serum concentration were （8.21±6.04） and （9.11±5.09）mg/L respectively;CSF norvancomycin concentration reached a peak of （16.31±11.15） and （8.82±8.91）mg/L in conventional administration group and continuous administration group respectively, 24hour CSF concentration were （6.12±2.34）and （5.71±4.72）mg/L respectively; CSF penetration rate of conventional administration group was calculated by ratio of area under curve （AUCCSF/AUCserum）, at 0-12 and 12-24 h hour were 63.3% and 59.0% respectively;in continuous administration group were 25.4% and 47.4% respectively. According to 95% of the minimum inhibitory concentration （MIC90） 2 mg/L of target bacteria methicillinresistant Staphylococcus aureus （MRSA）, AUC0-24/MIC90 in conventional administration group and continuous administration group were 192 and 184 respectively. ConclusionFor patients who receives early use of standard dose of norvancomycin after neurosurgery procedure, CSF drug concentration after convention and continuous administration of norvancomycin can both reach MIC90 against target bacteria.
出处
《中国感染控制杂志》
CAS
北大核心
2017年第5期393-398,共6页
Chinese Journal of Infection Control
基金
国家科技支撑计划基金资助项目(2012EP001004)
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
norvancomycin
continuous administration
serum drug concentration
cerebrospinal fluid drug concentration
pharmacokinetics /pharmacodynamics（PK/PD）
