中华神经外科杂志
中華神經外科雜誌
중화신경외과잡지
Chinese Journal of Neurosurgery
2011年
1期
73-76
,共4页
武元星%陈光强%王强%史中华%徐明%陈凯%陈律%雷燕妮%黄佳
武元星%陳光彊%王彊%史中華%徐明%陳凱%陳律%雷燕妮%黃佳
무원성%진광강%왕강%사중화%서명%진개%진률%뢰연니%황가
万古霉素%滴注,药物%血清药物浓度%药代动力学%药效动力学
萬古黴素%滴註,藥物%血清藥物濃度%藥代動力學%藥效動力學
만고매소%적주,약물%혈청약물농도%약대동역학%약효동역학
Vancomycin%Instillation,drug%Serum drug concentration%Pharmacokinetics%Pharmacodynamics
目的 探讨神经外科术后患者静脉持续输注万占霉素的血清药代与药效学特点.方法 选择开颅术后保留脑室引流患者12例.术后12 h内开始以万古霉素0.5 g泵入60 min,然后以2 g/24 h匀速持续泵入,在不同时间点采集静脉血和脑脊液标本,测定万占霉素浓度.结果 万古霉素0.5 g泵入结束即刻血药浓度达峰值(26.19 ±9.38)mg/L,2 h后浓度最低(7.87±2.25)mg/L,12 h后相对稳定(10.10±3.40)mg/L~(12.87±4.89)mg/L.万古霉素血清稳态药物浓度超过耐甲氧西林金黄色葡萄球菌对万占霉素90%最小抑菌浓度(MIC90)敏感折点(2 mg/L)5倍以上,以此计算,24 h血清药物浓度-时间曲线下面积(AUC)与MIC90的比值AUC0-24/MIC90为124.7;AUC24-48/MIC90为144.23;AUC48-72/MIC90为138.9.结论 对于高度耐药菌株,为保证AUC/MIC90大于400而提高疗效,提高剂量可能是需要的.
目的 探討神經外科術後患者靜脈持續輸註萬佔黴素的血清藥代與藥效學特點.方法 選擇開顱術後保留腦室引流患者12例.術後12 h內開始以萬古黴素0.5 g泵入60 min,然後以2 g/24 h勻速持續泵入,在不同時間點採集靜脈血和腦脊液標本,測定萬佔黴素濃度.結果 萬古黴素0.5 g泵入結束即刻血藥濃度達峰值(26.19 ±9.38)mg/L,2 h後濃度最低(7.87±2.25)mg/L,12 h後相對穩定(10.10±3.40)mg/L~(12.87±4.89)mg/L.萬古黴素血清穩態藥物濃度超過耐甲氧西林金黃色葡萄毬菌對萬佔黴素90%最小抑菌濃度(MIC90)敏感摺點(2 mg/L)5倍以上,以此計算,24 h血清藥物濃度-時間麯線下麵積(AUC)與MIC90的比值AUC0-24/MIC90為124.7;AUC24-48/MIC90為144.23;AUC48-72/MIC90為138.9.結論 對于高度耐藥菌株,為保證AUC/MIC90大于400而提高療效,提高劑量可能是需要的.
목적 탐토신경외과술후환자정맥지속수주만점매소적혈청약대여약효학특점.방법 선택개로술후보류뇌실인류환자12례.술후12 h내개시이만고매소0.5 g빙입60 min,연후이2 g/24 h균속지속빙입,재불동시간점채집정맥혈화뇌척액표본,측정만점매소농도.결과 만고매소0.5 g빙입결속즉각혈약농도체봉치(26.19 ±9.38)mg/L,2 h후농도최저(7.87±2.25)mg/L,12 h후상대은정(10.10±3.40)mg/L~(12.87±4.89)mg/L.만고매소혈청은태약물농도초과내갑양서림금황색포도구균대만점매소90%최소억균농도(MIC90)민감절점(2 mg/L)5배이상,이차계산,24 h혈청약물농도-시간곡선하면적(AUC)여MIC90적비치AUC0-24/MIC90위124.7;AUC24-48/MIC90위144.23;AUC48-72/MIC90위138.9.결론 대우고도내약균주,위보증AUC/MIC90대우400이제고료효,제고제량가능시수요적.
Objective Pharmacokinetics/pharmacodynamics of vancomycin in serum were studied after continuous infusion.Method Twelve neurosurgical postoperative patients with ventricular drainage were enrolled in this study.In each patient,a loading dose of vancomycin of O.5 g was administered for 1 h followed by a continuous infusion of 2 g/d.Venous blood specimens were collected ,vancomycin concentration in specimens were measured by high performance liquid chromatography.Results The peak vancomycin concentrations in serum were (26.19 ±9.38)mg/L,trough concentration occurred in 2 h(7.87 ±2.25 )mg/L,the relative steady state concentrations of vancomycin in serum ( 10.10 ± 3.40 )mg/L ~ ( 12.87 ± 4.89 )mg/Lwere achieved in 12 h, which exceeded the 90% minimum inhibitory concentration(2 mg/L) of common pathogens( Staphylococcus), and they were more than 5 -fold of MIC90, area under the serum concentration curve AUC0-24/MIC90 was 124.7; AUC24-48/MIC90 was 144.23; AUC48-72/MIC90 was 138.9.Conclusions Higher dosage is possibly necessary in order to reach AUC/MIC90 > 400 and better clinical outcome.