蒙特卡罗模拟法评价第一代头孢菌素预防手术部位感染的给药方案  

Evaluation on Administration Regimen of First-Generation Cephalosporins for Prevention of Surgical Site Infection by Monte Carlo Simulation

作　　者：张玉琴[1] 宋香清[2] Zhang Yuqin;Song Xiangqing(Xiangya Hospital Central South University, Hunan Changsha 410008, China;Hunan Cancer Hospital, Hunan Changsha 410013 , China)

机构地区：[1]中南大学湘雅医院,湖南长沙410008 [2]湖南省肿瘤医院,湖南长沙410013

出　　处：《儿科药学杂志》2019年第7期30-34,共5页Journal of Pediatric Pharmacy

摘　　要：目的:探讨第一代头孢菌素预防Ⅰ类切口手术部位感染的既往方案在目前微生物药敏结果下的预防效果。方法:基于药动学/药效学(PK/PD)理论利用蒙特卡洛模拟法进行探讨。以头孢唑林和头孢噻吩为考察药物,金黄色葡萄球菌、凝固酶阴性葡萄球菌和链球菌属为目标菌群,给药间期游离药物浓度位于最低抑菌浓度(MIC)之上的时间占一个给药间期的百分比(fT>MIC)为PK/PD靶指数,利用蒙特卡罗模拟头孢唑林和头孢噻吩既往方案对抗目标菌群达到PK/PD靶指数的累积反应分数(CFR)≥90%为标准探讨给药策略及预防效果。结果:对于成人(体质量以60 kg计),头孢唑林仅"1 g,q2h""2 g,q4h""3 g,q4h"和"术前1 g;术中0.5 g,q2h"的方案,头孢噻吩仅"2 g,q3h"和"术前2 g;术中1 g,q3h"的方案对各目标菌群的CFR≥90%,两者其他的既往方案均无法达到CFR≥90%标准。结论:应用第一代头孢菌素预防Ⅰ类切口手术部位感染时,应注意选择合适的给药方案(CFR≥90%),以确保预防效果。Objective: To explore the preventive effects of the first-generation cephalosporins for the prevention of infection in the surgical site of type Ⅰ incision under current microbial susceptibility.Methods: The Monte Carlo simulation based on the pharmacokinetics/pharmacodynamics( PK/PD) theory was used.Cefazolin and cefotaxime were set as the investigation drugs,Staphylococcus aureus,coagulase-negative Staphylococcus and Streptococcus were set as the targeted flora.The time during which the free drug concentration exceeded the minimum inhibitory concentration( MIC) during the dosing period as a percentage of the dosing interval( f T>MIC) was the PK/PD target index.The Monte Carlo simulation of cefazolin and cefotaxime was used to counter the target group,so as to achieve the cumulative reaction score( CFR) of ≥90% of the PK/PD target index as the standard to discuss the drug delivery strategy and preventive effects.Results: For adults( body mass measured as 60 kg),cefazolin was only"1 g,q2 h","2 g,q4 h","3 g,q4 h"and"1 g before surgery;0.5 g during surgery,q2 h",cefalotin was only"2 g,q3 h"and"2 g before surgery,1 g during surgery,q3 h",the CFR≥90% of each target flora could not meet the standard of CFR≥90% in other previous schemes.Conclusion: During application of the first-generation cephalosporins for the prevention of infection in the surgical site of type Ⅰ incision,more importance should be attached to select appropriate dosage regimen( CFR≥90%) to ensure protective effects.

关 键 词：药动学/药效学 蒙特卡罗模拟法 Ⅰ类切口 抗菌药物 头孢唑林 头孢噻吩 

分 类 号：R969.3[医药卫生—药理学]