神经外科手术后病人使用万古霉素时的脑脊液浓度

The CSF concentration of vancomycin in patients after neurosurgical operations

目的 了解神经外科病人术后使用万古霉素时的脑脊液浓度 ,初步探讨手术破坏血 脑屏障后 ,对万古霉素脑脊液浓度的影响。方法 病人术后静脉输入 1g万古霉素后 ,经术野和 (或 )脑室引流 (n =9)与腰穿留置导管引流 (n =10 )留取脑脊液标本 ,用高压液相色谱法测定药物浓度。结果 术野 /脑室引流组病人脑脊液中药物浓度普遍高于腰穿引流组 ,峰浓度均出现于给药后 15～ 30min ,分别是 6 .2 4± 3.4 6mg/L(n =8)和 4 .4 9± 3.14mg/L(n =10 ) ,达到或超过了耐甲氧西林金黄色葡萄球菌的MIC90 (0 .5～ 3.1mg/L)和耐甲氧西林表皮葡萄球菌的MIC90 (3.1～ 4 .0mg/L)以及脑膜炎时的药物浓度 2 .5～ 5 .0mg/L。此后 6h浓度两组分别为 3.6 8± 0 .84mg/L(n =8)和 2 .37± 0 .5 3mg/L(n =7) ,两组比较有显著性差异 (P <0 .0 5 ) ,12h浓度分别为 2 .5 5± 1.13mg/L(n =4 )和 2 .4 3± 0 .4 1mg/L(n =6 )。 结论 神经外科手术破坏了病人的血 脑屏障 ,使万古霉素脑脊液透过度增加 ,可达治疗浓度。据此结果可作为指导万古霉素对神经外科术中、术后相关颅内感染预防与治疗的参考。

Objective To evaluate the CSF concentrationof vancomycin in patients after neurosurgical operations,and to discuss the change of drug penetration after BBB integrality being injured after surgery.Methods After the surgery,1g vancomycin was injected intravenously,and then the CSF got from the surgical fields and/or intraventricular drainage (n=9) and from lumbar puncture drainage (n=10) were collected respectively.The CSF concentration of vancomycin was measured by HPLC.Results The CSF concentration of vancomycin in the surgical fields/ventricle group was significant higher than that of the lumbar puncture group.The peak concentration was found at 15～30 minutes after infusion of vancomycin,and the value were 6.24±3.46mg/L(n=8) and 4.49±3.14mg/L(n=10) respectively,which was equal to or higher than the MIC90 of MRSA (0.5～3.1mg/L),MIC90 of MRSE (3.1～4.0mg/L)and the concentration in meningitis (2.5～5.0mg/L).Six hours after the infusion,the concentration in the two group were 3.68± 0.84 mg/L (n=8) and 2.37±0.53mg/L(n=7),which still remained dominant difference ( P <0.05).The CSF concentration 12 hours after infusion were 2.55±1.13mg/L (n=4) and 2.43±0.41mg/L (n=6).Conclusions After the neurosurgical operations,the BBB of the patients were injured,which made the CSF penetration of vancomycin increased to a therapeutic concentration.It is suggested that vancomycin could be used for prevention and treatment for postoperative intracranial infection in the neurosurgical department.