开颅手术对脑脊液中药物浓度的影响

The study of the effect of craniotomy on the CSF drug concentration

目的通过测定开颅术后周围静脉血、皮下引流液及脑脊液中药物浓度,来评价开颅手术对脑脊液药物浓度的影响。方法开颅手术前半小时静脉滴注硫酸庆大霉素8万单位,6小时后分别测定周围静脉血、皮下引流液及脑脊液中庆大霉素浓度,分别对无需切开硬脑膜及需要切开硬脑膜的病例各20例进行对照观察。结果硬脑膜完整组:周围静脉血为0.47±0.15,皮下引流液为1.41±0.46,脑脊液0.27±0.18,以皮下引流液中浓度最高,周围静脉血其次,脑脊液最低,三者比较均有显著差异(P<0.01);硬脑膜开放组:周围静脉血为0.56±0.19,皮下引流液为1.28±0.75,脑脊液为0.52±0.15,亦是皮下引流液中浓度最高,但周围静脉血与脑脊液无显著差异(P>0.05)。两组之间周围静脉血以及皮下引流液无显著差异(P>0.05),而脑脊液有显著差异(P<0.01)。结论开颅术后的皮下引流液中含有较高的药物浓度,与脑脊液间存在着明显的浓度差,药物能通过脑脊液与皮下渗出液的交换而进入颅内,使脑脊液中的药物浓度上升。

Objective To evaluate the effect of craniotomy on the CSF drug concentration by measuring drug concentration in blood, in subcutaneous transudation and in CSF. Methods 40 patients enduring craniotomy were admitted in the study, 20 patients in the dura intact group, while another 20 in the dura open group. All patients were injected Gentamycin Sulfate 80 thousand unit preoperation. The drug level of Gentamycin in blood, subcutaneous transudation and CSF were determined at 6 hours after operation. Results Gentamycin concentration of the dura intact group： 0.47~0.15 in blood, 1.41~0.46 in subcutaneous transudation, 0.27~0.18 in CSF. That of subcutaneous transudation was the highest, blood was the second, CSF was the last, there were significant difference among these subgroups （P〈0.01）; Gentamycin concentration of the dura opened group： 0.56±0.19 in blood, 1.28±0.75 in subcutaneous transudation, 0.52±0.15 in CSF, subcutaneous transudation was the highest also, but there were no significant difference between blood and CSF （P〉0.5）： Compared the two groups, there were no significant difference between the blood drug levels, so were the concentration of the subcutaneous transudations （P〉0.5）, but were significant difference between those of CSF. Conclusion The drug concentration in subcutaneous transudation is higher than that of in CSF, therefore drug concentration in CSF can rise by exchanging between endocranial and extracranial via opened dura.