多黏菌素治疗呼吸机相关性肺炎患者肺组织浓度与血药浓度关系

Relationship of Polymyxins Between Intrapulmonary Concentration and Blood Concentration in Patients with Ventilator-associated Pneumonia

目的探讨多黏菌素治疗呼吸机相关性肺炎时患者肺组织浓度与血药浓度关系。方法回顾多黏菌素的药理学作用,介绍多黏菌素的肺组织浓度检测和计算方法,总结多黏菌素治疗呼吸机相关性肺炎后肺组织浓度、血药浓度和肺组织渗透性,分析多黏菌素的肺组织浓度和血药浓度关系。结果多黏菌素经静脉输注时,上皮细胞衬液浓度显著低于血药浓度,甚至低于检测限;但多黏菌素经雾化吸入时,到达肺组织的药物浓度显著提高,上皮细胞衬液中药物浓度可高达血药浓度的100~1 000倍;无论静脉输注还是雾化吸入,多黏菌素给药剂量越大,其肺组织浓度和血药浓度越高。结论多黏菌素治疗呼吸机相关性肺炎时,应重点关注其在患者肺组织的浓度,给药途径的调整可帮助临床更有效地使用多黏菌素。

Objective To explore the relationship between intrapulmonary concentration and blood concentration of polymyxin in patients with ventilator-associated pneumonia.Methods The pharmacological effects of polymyxins were reviewed.Detection and calculation methods for the polymyxin concentration in lung tissue were introduced.The intrapulmonary concentration,blood concentration and lung tissue penetration of polymyxins in patients with ventilator-associated pneumonia were summarized.The relationship between intrapulmonary concentration and blood concentration was analyzed.Results When polymyxin was administered intravenously,the concentration was significantly lower in epithelial lining fluid than in the blood,or even below the detection limit;however,when polymyxin was administered by inhalation,the drug concentration in the lung was increased significantly,and the drug concentration in epithelial lining fluid could reach 100 to 1000 times over blood concentration.The greater the dose of intravenous infusion or aerosol inhalation was administered,the higher the concentration of polymyxins in the blood and lung tissue.Conclusion In the treatment of ventilator-associated pneumonia,more attention should be paid to the intrapulmonary concentration of polymyxins in patients,and adjustment of the administration route can help make the clinical use of polymyxins more effective.