硝基咪唑类抗菌药在急性重症胆源性胰腺炎患者胆汁中代谢特点的实验研究

Study on the metabolic characteristics of Nitroimidazole in bile of severe acute biliary pancreatitis

目的探讨部分硝基咪唑类抗菌药在急性胆源性胰腺炎胆汁中的代谢特点,为临床选择抗菌药提供实验依据。方法选择我院2009年6月—2010年9月住院治疗的急性重症胆源性胰腺炎病人68例,随机分成治疗组Ⅰ和治疗组Ⅱ各34例。68例病人均在入院48 h内行内镜逆行胰胆管造影,并通过经内镜鼻胆管引流术留取胆汁,两组在给予头孢哌酮治疗的基础上分别给予甲硝唑和替硝唑治疗,利用高效液相色谱法,连续动态监测给药后胆汁药物浓度的变化。结果甲硝唑具有达峰时间短,峰浓度高的特点,而替硝唑达峰时间长,但是胆汁中药物浓度稳定。结论甲硝唑具有达峰时间短,峰浓度高的特点,是临床治疗重症胆源性胰腺炎(SAP)合并胆道感染的最佳抗菌药。

Objective To investigate metabolic characteristics of Nitroimidazoles in bile of severe acute biliary pancreatitis,to provide the experimental evidence for selecting antimicrobial drug in clinic.Methods 68 patients of severe acute biliary pancreatitis（SAP） chosen from our hospital from June 2009 to September 2010 were randomly divided into 2 groups,each group consisted of 34 cases,all cases underwent encoscopic retrograde cholangio-pancreatography（ERCP） and endoscopic nasobiliary drainage（ENBD） within 48h after hospitalization.Cefoperazone were applied in 2 groups.Metronidazole was applied in group Ⅰ,and Tinidazole in groupⅡ.Drug concentrations in human biles were measured by high performance liquid chromatography（HPLC） dynamically.Results Metronidazole has less peak time,higher peak concentration and Tinidazole has longer peak time,longer drug concentration stably.Conclusion Metronidazole has less peak time,higher peak concentration in human bile of SAP.It is the best choice for treating SAP and infection of biliary tract.