颅脑外科手术患者术中预防使用抗菌药物追加时机与次数研究  

Additional delivery timing and number of times of intraoperative antibiotics prophylaxis for patients undergoing cerebral surgery

作　　者：宋香清[1] 龙明辉[1] 杨立平[1] 曹丽芝[1] 谌赟[1] 

机构地区：[1]湖南省肿瘤医院药学部,湖南长沙410013

出　　处：《中华医院感染学杂志》2016年第18期4151-4154,共4页Chinese Journal of Nosocomiology

基　　金：湖南省卫生计生委科研基金资助项目(c2015-49)

摘　　要：目的研究颅脑外科手术患者术中预防使用抗菌药物追加时机和次数,促进临床围手术期合理给药,预防切口感染可能。方法结合实例,以药动学模型为基础,以fT>MIC%达到100.0%为目标阈值,结合抗菌药物的有效覆盖时间确定术中追加时机和追加次数。结果颅脑外科手术患者术中抗菌药物的追加时机应以上一剂抗菌药物的浓度下降至MIC的时间点为准,以此类推,根据术前用药时机、手术历时及术后4h的整个时间段确定术中(后)追加次数。结论依据抗菌药物的PK/PD特性从理论上探讨了颅脑外科手术围手术期术中追加时机和追加次数的问题,可初步指导术中追加时机和追加次数的合理制定。OBJECTIVE To study the additional delivery timing and number of times of intraoperative antibiotic prophylaxis for patients undergoing cerebral surgery so as to promote the reasonable clinical use of antibiotics during perioperative period and prevent incision infections.METHODS On the basis of real cases,the additional delivery timing and number of times of intraoperative antibiotic prophylaxis were determined based on the pharmacokinetics model,by setting 100.0% of fT〉MIC%as the target threshold,and by combining with the effective cover time of antibiotics.RESULTS The intraoperative additional delivery timing of antimicrobial agents should be determined with the time point when the concentration of foregoing dose of antibiotic decreased to MIC,in the same way,the intraoperative（postoperative）additional delivery times were determined according to the preoperative medication timing,operation duration,and entire time period of 4hafter surgery.CONCLUSION The additional delivery timing and number of times of intraoperative antibiotic prophylaxis are theoretically explored for the patients undergoing the cerebral surgery based on the PK/PD features of antibiotics,which may provide preliminary guidance for reasonable formulation of intraoperative additional delivery timing and number of times.

关 键 词：T〉MIC 颅脑外科手术 围手术期 追加时机 追加次数 头孢唑林 头孢呋辛 头孢曲松 

分 类 号：R378.1[医药卫生—病原生物学]