神经外科术后感染患者万古霉素脑脊液穿透率测定及相关因素分析

Determination of the cerebrospinal fluid penetration rate of vancomycin and related factors in patients with postoperative infection in department of neurosurgery

目的了解神经外科术后感染患者万古霉素脑脊液穿透率及影响因素,为临床治疗提供参考依据。方法选取2015年3月-2016年6月11例开颅术后感染患者作为研究对象,通过酶放大免疫检测技术测定血清和脑脊液中万古霉素浓度,计算穿透率及相关因素。结果患者万古霉素平均血清药物浓度为(9.89±2.97)mg/L,脑脊液浓度为(2.34±1.98)mg/L,穿透率为(0.22±0.16)%;万古霉素血药浓度与体重有明显相关性(P<0.05),与年龄及血肌酐水平不相关;而万古霉素脑脊液穿透率与脑脊液白细胞计数可能相关(P<0.05),与脑脊液糖浓度及蛋白浓度不相关。结论常规剂量万古霉素在血及脑脊液中浓度较低,建议根据患者体重计算给药剂量并监测万古霉素血和脑脊液浓度。

OBJECTIVE To understand the penetration rate of cerebrospinal fluid of vancomycin and its influencing factors in patients with postoperative infection in department of neurosurgery,so as to provide references for clinical treatment.METHODS Eleven patients with post-craniotomy infection from Mar.2015 to Jun.2016 were selected as study subjects.The concentrations of vancomycin in serum and cerebrospinal fluid were determined by enzyme amplified immunoassay,and the penetration rate and related factors were calculated.RESULTS The vancomycin concentrations in serum and cerebrospinal fluid was 9.89±2.97mg/L and 2.34±1.98mg/L,respectively.The penetration rate was 0.22±0.16.There was a significant correlation between the serum concentration of vancomycin and the weight of the patients（P〈0.05）,neither the age nor the serum creatinine was correlated with the serum concentration of vancomycin.Cerebrospinal fluid white blood cell count,but not the cerebrospinal fluid protein and cerebrospinal fluid glucose, was correlated to the penetration rate of vancomycin（P〈0.05）.CONCLUSIONConventional dose of vancomycin leads to low concentrations in the serum and cerebrospinal fluid,so it is recommended to calculate the dose of vancomycin according to the patient＇s body weight and monitor vancomycin concentrations in serum and cerebrospinal fluid in patients.