大面积烧伤患者早期应用万古霉素的药代动力学研究  

Research the pharmacokinetics of vancomycin in large area severe burn patients during the early phase

作　　者：覃凤均[1] 卞婧[2] 田彭[1] 黎明[1] 沈余明[1] QIN Feng-jun;BIAN Jing;TIAN Peng;LI Ming;SHEN Yu-ming(Department of Burns,Beijing Jishuitan Hospital,Beijing 100035,China;Department of Pharmaceutical,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院烧伤科,北京100035 [2]北京积水潭医院药剂科,北京100035

出　　处：《中国医刊》2020年第3期287-290,共4页Chinese Journal of Medicine

基　　金：北京市科学技术委员会资助项目（Z161100000516133）

摘　　要：目的通过检测大面积烧伤患者早期应用万古霉素后血液及水泡液中的药物浓度,进一步研究其在血液及水泡液中的药代动力学特点,为大面积烧伤患者早期合理应用万古霉素提供参考。方法选择2016年6月至2018年10月北京积水潭医院收治的16例烧伤总面积大于50%体表总面积的患者,入院后2h内开始给予万古霉素1.0g溶解于250ml的0.9%氯化钠溶液中静脉滴注,60min匀速滴完,每12h给药1次。首次用药前和首次用药后0.5、1、2、4、8、12、24、48h分别采集静脉血2ml及水泡液1ml,用高效液相色谱法测定血液和水泡液中的万古霉素浓度,采用3P97实用药代动力学程序自动拟合并计算药代动力学参数及处理药物浓度数据。结果用药后1h血液及水泡液中万古霉素药物浓度均达到高峰,用药后0.5h及1h血液中药物浓度高于水泡液中,差异有显著性(P<0.05)。用药后,水泡液中万古霉素在体内分布的表观一级速度常数、消除的表观一级速度常数、分布相半衰期、消除相半衰期、周边室向中央室的转运速度常数、中央室的消除速度常数、中央室向周边室的转运速度常数、曲线下面积及总体清除率与血液中比较,差异均有显著性(P<0.05)。16例患者未发生肝肾损害与听力损害情况。结论大面积严重烧伤患者早期应用万古霉素后在水泡液中半衰期明显长于血液中,且体内药代动力学差异较大,应进行药物浓度监测并根据患者的具体情况调整药物剂量。Objective To research the pharmacokineics characteristics of vancomycin by determine the concentration of vancomycin in blood and blister fl uid,and Provide reference basis to rational application of vancomycin in large area severe burn patients during the early phase post burn.Method Sixteen severe burn patients with more than 50%TBSA burns from June 2016 to October 2018 were selected,and received intraveneous injection of 1.0 gram vancomycin at an even rate for 60 mins within 2 hours after admission,once every 12 hours.Two ml blood and 1ml blister fl uid were collected before use drug and at 0.5h、1h、2h、4h、8h、12h、24h、48h after use drug,the concentration of vancomycin in blood and blister fl uid were determined by high effi ciency liquid chromatography(HPLC),Pharmacokinetic parameters of vancomycin were produced by program 3P97.Result The concentration of vancomycin in blood and blister solution reached a peak 1h after medication.The concentration of vancomycin in the blood was higher than that in blisters for 0.5h after medication and 1h after medication(P<0.05).After medication,theα、β、t1/2α、t1/2β、K21、K10、K12、AUC、CLs in the vesicular solution were signifi cantly diff erent from those in the blood(P<0.05).No liver,kidney and hearing impairment occurred in 16 patients.Conclusion Compared with healthy people,clearance was obviously increased,halfl ife was obviously shortened,maximum and trough concentration was remarkably low in large area severe burn patients during the early phase post burn after application of vancomycin,the half-life of vancomycin in blister fl uid were obviously longer than that in blood,the pharmacokinetic parameters are varied in diff erent individuals,the concentration should be monitored and the treatment should be adjusted timely to guarantee safety and validity.

关 键 词：药代动力学 烧伤 万古霉素 水泡液 

分 类 号：R644[医药卫生—外科学]