人工髋关节置换术后患者血清与手术切口渗出液中万古霉素的药物含量变化

The change of vancomycin content in serum and surgical incision exudate after total hip arthroplasty

目的探讨在人工髋关节置换术(THA)中选用万古霉素关节腔局部给药时患者血清中与手术切口渗出液中万古霉素的药物浓度的变化与比较。方法本研究中自2016年1月-2017年1月在我科行接受THA手术的患者中选取46例单侧初次全髋关节置换术(Total hip Arthroplasty,THA)患者入选;术区使用2 g万古霉素,且术后24 h之内不同的时间段检测患者血清及切口渗出液中药物含量。结果研究中得出血清药物浓度相对较低,术后24 h内均<18 ug/m L,其在术后12 h时达到高峰,术后24 h内平均药物浓度为(4.5±3.1)ug/m L。切口渗出液中药物浓度在术后3 h和24 h时分别为(852±323)ug/m L和(217±114)ug/m L,显著高于血清中药物浓度(P<0.05)。结论在人工关节置换术中局部使用万古霉素能够在关节腔内产生较高浓度的药物环境,且能够使全身药物浓度较低,避免造成全身性药物副作用。万古霉素能够有效和安全的预防关节假体感染的发生。

Objective To investigate the changes of vancomycin concentrations in serum and incision exudate in patients undergoing total hip arthroplasty（THA）using vancomycin local drug delivery.Methods In this study,46 patients with unilateral THA were enrolled in our department who underwent THA surgery from January 2016 to January 2017;2g vancomycin was used in the operation area,and drug contents in serum and incision exudate of patients was detected at different time within 24h after operation.Results The study showed：The serum drug concentration was relatively low,and less than 18 ug/mL in the postoperative 24h,which peaked at 12h after operation,and the average drug concentration was 4.5（ug/mL ± 3.1）after 24h.The drug concentration in incision exudate was 852 ug/mL±323 and 217 ug/mL± 114 after postoperative 3H and 24h respectively,which was significantly higher than that of in serum（P〈0.05）.Conclusion The local use of vancomyein in THA can produce a high concentration of drug environment in the joint cavity,and can make the whole body drug concentration lower,avoid causing systemic drug side effects.Vancomycin is effective and safe in preventing the occurrence of joint prosthesis infection.