CAJ | 학술논문

目的在体外模拟实验中,观察平衡超滤技术对于围手术期血浆抗生素浓度的影响.方法建立体外循环体外模拟环路,在平衡超滤期间定期取血浆和超滤液样本,采用高效液相色谱检测技术,对两种抗生素头孢替安和头孢美唑药物浓度分别进行动态监测.结果不同时点超滤液中均可检测到头孢替安及头孢美唑的存在.随着超滤液的增加,血浆中抗生素浓度呈现线性降低.至45 min超滤结束前,血浆头孢替安由初始浓度(238.95±101.12) μg/ml降低至(104.96±44.36) μg/ml,而血浆头孢美唑由初始浓度(51.49±28.03) μg/ml降低至(25.76±14.78)μg/ml;超滤液中头孢替安总含量占总给药量的(27.16±12.17)％,头孢美唑总含量占总给药量的(7.74±4.17)％.结论平衡超滤技术可以滤除血液中的抗生素,超滤量与蛋白结合率显著相关;超滤技术对于围手术期抗生素的血药浓度具有显著影响,抗生素药物剂量调整需要考虑这一影响因素.
목적 재체외모의실험중,관찰평형초려기술대우위수술기혈장항생소농도적영향.방법 건입체외순배체외모의배로,재평형초려기간정기취혈장화초려액양본,채용고효액상색보검측기술,대량충항생소두포체안화두포미서약물농도분별진행동태감측.결과 불동시점초려액중균가검측도두포체안급두포미서적존재.수착초려액적증가,혈장중항생소농도정현선성강저.지45 min초려결속전,혈장두포체안유초시농도(238.95±101.12) μg/ml강저지(104.96±44.36) μg/ml,이혈장두포미서유초시농도(51.49±28.03) μg/ml강저지(25.76±14.78)μg/ml;초려액중두포체안총함량점총급약량적(27.16±12.17)％,두포미서총함량점총급약량적(7.74±4.17)％.결론 평형초려기술가이려제혈액중적항생소,초려량여단백결합솔현저상관;초려기술대우위수술기항생소적혈약농도구유현저영향,항생소약물제량조정수요고필저일영향인소.
Objective Routine perioperative intravenous antimicrobial agents,was administered as surgical prophylaxis.However,whether balanced ultrafiltration during extracorporeal circulation can remove antimicrobial agent remains unclear.The concentrations of antimicrobial agent in plasma and ultrafiltrate samples were measured in this pseudo-extracorporeal circulation model.Methods Extracorporeal circulation consisted of cardiotomy reservoir (Ningbo Fly Medical Healthcare CO.,LTD.Ningbo,China),D902 Lilliput 2 membrane oxygenator (Sorin Group Asia Pte Ltd,Beijing,China) and Capiox (R) AF02 pediatric arterial line filter (Terumo Corporation,Beijing,China).HEMOCONCENTRATOR BC 20 plus (MAQUET Cardiopulmonary AG,Hirrlingen,Germany) was placed between arterial purge line and oxygenator venous reservoir.Fresh donor human whole blood was added into the circuit and mixed with Ringer's solution to obtain a final hematocrit of 24％-28 ％.After 30 minutes of extracorporeal circulation,zero-balanced ultrafiltration was initiated and arterial line pressure was maintained at approximately 100 mm Hg(1 mm Hg =0.133 kPa) with Hoffman clamp.The rate of ultrafiltration (12 ml/min) was controlled by ultrafiltrate outlet pressure.Identical volume of plasmaslyte A was dripped into the circuit to maintain stable hematocrit during 45 minutes of experiment.Plasma and ultrafiltrate samples were drawn every 5 minutes and concentrations of antimicrobial agent (including Cefmetasole and cefotiam) were measured with high performance liquid chromatography.Results All these two antimicrobial agents were detected in ultrafiltrate,demonstrating hemoconcentration may remove antimicrobial agent.The concentration of plasma antimicrobial agent decreased lineally with the increase of ultrafiltrate volume.At end of balanced ultrafiltration,the concentration of plasma cefotiam was (104.96 ± 44.36) μg/ml,which is about (44.38 ± 7.42) ％ of the initial concentration (238.95 ± 101.12) μg/ml; the concentration of plasma cefmetazole decreased linearly to (25.76 ± 14.78) μg/ml,which is about (49.69 ± 10.49) ％ of the initial concentration (51.49 ± 28.03) μg/ml.The total amount of cefotiam in ultrafiltrate is (27.16 ± 12.17)％ of the total dose administered,whereas cefmetasole in ultrafiltrate is (7.74 ±4.17)％.Conclusion Balanced ultrafiltration may remove antimicrobial agent from serum and has significant influence on plasma concentration of antimicrobial agent.The strategy of surgical prophylaxis should consider this unique technique during extracorporeal circulation.