CAJ | 학술논문

目的：探讨神经外科术后患者静脉持续输注较大剂量万古霉时脑脊液药物浓度变化规律，并初步观察其安全性。方法选择开颅术后保留脑室引流管，主管医生决定使用万古霉素的患者。开始以万古霉素1.0 g泵入1 h，后以3 g/24 h匀速持续泵入，顺序采取脑脊液标本，测定万古霉素浓度。结果共有24例患者入选，万古霉素首剂负荷量1 g泵入结束2 h后脑脊液的药物浓度达到相对稳定：（1.45±1.24）mg/L～（3.43±1.43）mg/L。万古霉素脑脊液稳态药物浓度达到并超过神经外科术后颅内感染常见致病菌耐甲氧西林金黄色葡萄球菌（MRSA）的 MIC （≤1.0 mg/L），其脑脊液穿透率，以脑脊液与血清药物浓度-时间曲线下面积之比计算，每24 h 分别为16.1%、13.3%、8.6%。所有入组患者均未出现任何不良反应。结论较大剂量万古霉素（3 g/d）与常规剂量（2 g/d）相比，静脉持续输注时，脑脊液可以较快达到有效浓度，即达到或超过颅内感染主要致病菌的MIC水平，而且初步观察该治疗是安全的，但本研究样本量小，结果仅为阶段性结果，仍需进一步的大样本的临床研究论证。
목적：탐토신경외과술후환자정맥지속수주교대제량만고매시뇌척액약물농도변화규률，병초보관찰기안전성。방법선택개로술후보류뇌실인류관，주관의생결정사용만고매소적환자。개시이만고매소1.0 g빙입1 h，후이3 g/24 h균속지속빙입，순서채취뇌척액표본，측정만고매소농도。결과공유24례환자입선，만고매소수제부하량1 g빙입결속2 h후뇌척액적약물농도체도상대은정：（1.45±1.24）mg/L～（3.43±1.43）mg/L。만고매소뇌척액은태약물농도체도병초과신경외과술후로내감염상견치병균내갑양서림금황색포도구균（MRSA）적 MIC （≤1.0 mg/L），기뇌척액천투솔，이뇌척액여혈청약물농도-시간곡선하면적지비계산，매24 h 분별위16.1%、13.3%、8.6%。소유입조환자균미출현임하불량반응。결론교대제량만고매소（3 g/d）여상규제량（2 g/d）상비，정맥지속수주시，뇌척액가이교쾌체도유효농도，즉체도혹초과로내감염주요치병균적MIC수평，이차초보관찰해치료시안전적，단본연구양본량소，결과부위계단성결과，잉수진일보적대양본적림상연구론증。
Objective To study the pharmacokinetics/pharmacodynamics of vancomycin in cerebrospinal fluid (CSF) after continuous infusion. Methods Twenty-four neurosurgical postoperative patients with ventricular drainage were enrolled into this study. In each patient, a loading dose of 1 g vancomycin of was administered for 1 h followed by a continuous infusion of 3 g during the 24 hours. CSF specimens were collected. Results The steady state concentrations in the CSF [(2.23±1.20)mg/L~(3.42±1.18)mg/L] were achieved after 2 h, which exceeded the minimum inhibitory con-centration [MIC(≤1.0 mg/L)] of common pathogens (MRSA) in intracranial infection. The penetration rate of vancomycin in CSF, represented by the proportion of area under the CSF concentration curve and the area under the serum concen-tration curve, was 16.1%, 13.3% and 8.6% every 24 hour respectively. No patients had side effects or adverse reactions. Conclusion Higher dosage is possibly necessary to reach good pharmacokinetics/pharmacodynamics index. This prelim-inary observation has shown that the treatment is safe, but the present study only has limited number of samples, and on-ly has the limited stage outcome, further clinical studieswith of large samples are necessary.