静脉用环丙沙星在开放性眼外伤眼内渗透性研究

Clinical study on the ocular penetration of intravenous ciprofloxacin in open globe injury of human eyes

目的探讨在开放性眼外伤患者单剂量静脉滴注环丙沙星的眼内渗透性。方法选择16例非化脓开放性眼外伤和12例住院白内障手术为正常对照的患者，单次静脉滴注环丙沙星注射液200mg后1h抽取少许房水和玻璃体，采用高效液相色谱法检测眼内环丙沙星浓度，双缩脲法检测房水蛋白含量。结果正常对照组的房水蛋白含量是（0．067±0．037）g／L，开放性眼外伤组是（6．482±2．981）g／L，开放性眼外伤组的房水蛋白含量明显高于正常对照组，P〈0．05。在对照组房水中环丙沙星浓度是（0．158±0．035）μg／ml，开放性眼外伤组房水中环丙沙星浓度是（0．175±0．142）μg／ml，开放性眼外伤组与对照组相比P〉0．05，浓度差异无统计学意义。开放性眼外伤组玻璃体中环丙沙星浓度（0．082±0．022）μg／ml，环丙沙星在眼内不能达到眼内炎常见致病菌的体外90％最小抑菌浓度（（MIC90）。结论在开放性外伤眼的血房水屏障破坏，但环丙沙星眼内渗透性并没有增强，单剂量静脉滴注后不能在眼内达到有效的抑菌浓度，在围手术期用药不能达到预期的抗菌效果。

Objective To assess the ocular penetration of ciprofloxacin in open globe injury of human eyes after a single dose intravenous administration.Methods In this prospective study, 16 patients with non-purulent open globe injury were studied.The normal control group included 12 patients underwent cataract surgery.All the patients received continuously intravenous infusion of 200mg ciprofloxacin before surgery.The aqueous samples were obtained in both group and in open globe injury group vitreous humour samples were also obtained.Drug concentrations were measured using high-pressure liquid chromatography analysis and protein concentration of aqueous humor was measured by biuret conorimetric method simultaneously.Results 1.The protein concentration of aqueous humor in open globe injury group （6.482±2.981 g/l）were significantly higher than that of the control group （0.067±0.037g/1）, （P〈0.05）.2.The ciprofloxacin concentration of aqueous humor in open globe injury group and the control group were 0.175±0.142μg/ml and 0.158±0.035μml respectively.There were no significant difference between the two groups （P〉0.05）.3.The vitreous concentration of ciprofloxacin in open globe injury group was 0.082±0.022μg/ml.The vitreous levels of ciprofloxacin in open globe injury group could not exceed the 90% minimum inhibitory concentration（MIC90 ）of common ocular pathogens causing endophthalmitis.Conclusions In the open-globe injured eye the blood-ocular barrier was damaged, but the ocular penetration of ciprofloxacin didn＇t enhance.The levels of intraocular ciprofloxacin after a single dose of intravenous administration couldn＇ t reach effective therapeutic concentration.