脑室内注射万古霉素治疗术后颅内感染的方法学及药代动力学研究  

Methodology and pharmacokinetics study of intraventricular administration on vancomycin in patients with intracranial infections after craniotomy

作　　者：陈凯[1] 王佳庆[2] 武元星[1] 李新刚[2] 王强[1] 赵志刚[2] 周建新[1] 

机构地区：[1]首都医科大学附属北京天坛医院ICU,100050 [2]首都医科大学附属北京天坛医院药剂科,100050

出　　处：《临床神经外科杂志》2014年第6期435-439,共5页Journal of Clinical Neurosurgery

摘　　要：目的了解脑室内和静脉联合使用万古霉素治疗神经外科术后颅内感染时脑脊液内药代动力学及理化性质变化规律,为建立颅内局部给药方法的标准提供依据。方法选择开颅术后留置术腔/脑室引流管的颅内感染患者10例,万古霉素q12 h静脉给予1 g,持续泵入2 h,同时,经引流管术腔/脑室局部给予10 mg。分别于给药前、后相应时间点采集静脉血及脑脊液标本测定药物浓度及理化性质。结果万古霉素给药开始后1 h血药浓度达到(41.08±15.83)mg/L,48 h谷浓度为(8.10±7.11)mg/L;脑脊液浓度给药后0.25 h为(412.71±464.81)mg/L,48 h谷浓度为(33.62±31.95)mg/L。理化性质无明显变化。结论通过静脉加小剂量脑室给药,可以提高脑脊液万古霉素浓度,可能成为治疗开颅术后严重颅内感染的一种选择,但其安全性、有效性尚需更大规模的研究证实。Objective To learn the pharmacokinetics of intraventricular and intravenous administration of vancomycin for the patients with intracranial infections after neurosurgical operations, to provide the basis for the criterion of the intracranial local administration.Methods 10 neurosurgery postoperative patients with surgical cavity/ventricular drainages who had been diagnosed with intracranial infections,vancomycin 1.0 g,intravenous infusion for 2 hours,q12 h,at the same time, intraventricular injection was given 10 mg.Collect blood and cerebrospinal fluid （ CSF ） specimens before and after the administration at the corresponding time points, then the drug concentrations would be measured.Results After the administration of vancomycin at the first time, the 1h serum drug concentration reached （41.08 ±15.83） mg/L, and the trough concentration of 48 h reached （8.10 ±7.11） mg/L;meanwhile the 0.25h CSF drug concentration reached a peak of （412.71 ±464.81 ） mg/L, and the trough concentration of 48 h reached （ 33.62 ±31.95 ） mg/L. Conclusions Without increasing the dose, it can improve the vancomycin concentrations in CSF by intraventricular and intravenous administration,and has no side effects.The results of our study show that intraventricular and intravenous administration can be an option for the treatment of severe intracranial infections after neurosurgical operations,but its safety and effectiveness need to be confirmed by large-scale studies.

关 键 词：万古霉素 脑室内给药 神经外科手术部位感染 颅内感染 药代动力学 

分 类 号：R512.3[医药卫生—内科学]