不同膀胱病理状态下庆大霉素膀胱冲洗的安全性考察

The Safety of Gentamicin Bladder Irrigations in Different Pathological Conditions

目的：考察庆大霉素（GTM）膀胱冲洗在细菌性膀胱炎及出血性膀胱炎下的安全性。方法：收集接受GTM膀胱冲洗患者给药后30min的血液（80mg，2次／d），以荧光偏振免疫法（FPIA法）测定血药浓度；12只Wistar大鼠随机等分为对照组和模型组，模型组腹腔注射环磷酰胺140mg／kg构建出血性膀胱炎模型，并以苏木精一伊红染色法（hematoxylin—eosinstaining，HE染色法）观察造模结果。造模24h后，两组大鼠分别给予GTM8．4mg/kg膀胱内注射，FPIA法测定给药30min后血药浓度。结果：共有8例次患者进入实验，监测GTM平均血药浓度为0．234μg／mL（0．14～0．40μg／mL）；模型组大鼠在接受GTM膀胱内注射后平均血药浓度为（7．53±1．32）μg／mL，与对照组（0．63±O．12）μg／mL相比有显著统计学差异（P〈0．01）。结论：GTM膀胱冲洗对于细菌性膀胱炎是安全的，但应避免用于出血性膀胱炎患者。

Objective：To assess the safety of gentamicin bladder irrigations in patients with bacterial cystitis or hemorrhagic cystitis. Methods：Blood was collected from the patients who had received gentamicin bladder irrigations （80 mg of gentamicin, twice a day）. FPIA method was used to test the gentamicin concentration. Twelve Wistar Rats were used and divided randomly into model and control groups. The hemorrhagic cystitis rat model was set up by intraperitoneal injection with 140 mg/kg CTX and justified by HE staining. 24 h later, the rats of the two groups were treated with 8.4 mg/kg gentamicin bladder irrigations, and the concentration of gentamiein was tested by FPIA method. Results ： Eight patients were enrolled in this study and the tested concentrations of gentamicin were ranged from 0.14 to 0.40 μg/mL with a median value of 0.234 p.g/mL. In the animal study, the tested median concentration of gentamicin in hemorrhagic cystitis rat model was （7.53 _＋ 1.32 ） μg/mL, much higher than the control group（0.63 ＋0.12 ） μg/mL （P 〈 0.01）. Conclusion ： Gentamicin bladder irrigations were proved safety in use in the patients with bacterial cystitis, but should not be used in the patients with hemorrhagic cystitis.