抗菌药物在妊娠及哺乳期妇女组织体液中的分布  

Tissue and Body Fluid Distribution of Antibacterial Agents in Pregnant and Lactating Women

作　　者：张婴元[1,2] 张菁[1,2] 徐箴[1,2] 袁道源 郁继诚[1,2] 施耀国[1,2] 黄紫蓉 闻政[1,2] 钱宇荫 王磊 杜明昆[1,2] 

机构地区：[1]上海医科大学华山医院抗生素研究所 [2]上海医科大学妇产科医院

出　　处：《中华妇产科杂志》1997年第5期288-292,共5页Chinese Journal of Obstetrics and Gynecology

基　　金：国家自然科学基金

摘　　要：目的：了解抗菌药物对血－胎盘屏障的穿透性和其在乳汁中的分泌。方法：采用微生物法或高效液相层析法对妊娠妇女和哺乳期妇女进行了１３种抗菌药物的组织体液浓度测定。结果：甲硝唑、氧氟沙星、氯霉素、庆大霉素和氨苄西林对血－胎盘屏障的穿透性高；青霉素类（除氨苄西林外）和头孢菌素类穿透性低，但在大多组织和体液中仍可达治疗水平；阿米卡星、克林霉素和红霉素的穿透性略高于β－内酰胺类。乳汁中药物浓度大多低微，但甲硝唑和红霉素的乳汁浓度高于母血浓度。结论：根据研究结果，并考虑到抗菌药物对母体和胎儿可能产生的不良影响，以及药物的不同抗菌活性，提出妊娠期和哺乳期抗菌治疗的适应证及其合理应用方案。Objective: To determine the placental transfer and milk excretion of antibacterial agents. Methods: A prospective study was conducted in pregnant and lactating women. The concentrations of 13 agents in tissue and body fluid were determined by bioassay or high performance liquid chromatography method. Results: The results showed that metronidazole, ofloxacin, chloramphenicol, gentamicin and ampicillin crossed blood placental barrier well, the ratio of fetal tissue or amniotic fluid/maternal serum drug concentration was higher than those of the other agents. The penetration of penicillins (except ampicillin) and cephalosporins was poor, but the drug concentrations were still reached therapeutic levels in the most tissues and body fluids. The placental transfer of amikacin, clindamycin and erythromycin was slightly higher than β lactams. The drug concentrations in breast milk was low, except metronidazole and erythromycin, the breast milk levels of the two drugs were more than 100% of maternal serum levels. Conclusion: Based on the results of the study and the consideration of possible adverse effects which may affect both the mother and the developing fetus as well as antibacterial activities of the drugs, the indications and resonable use of the agents in pregnant and lactating period were recommended.

关 键 词：泌乳 抗感染药 组织体液浓度 测定 妊娠 

分 类 号：R978[医药卫生—药品] R969.3[医药卫生—药学]