载万古霉素骨水泥与人工骨人体局部释放对比分析

Comparative analysis of local release of vancomycin-loaded bone cement and artificial bone in human body

目的通过测定载万古霉素骨水泥、人工骨植入骨感染患者体内后全身及局部的药物浓度,对比万古霉素骨水泥及人工骨的局部释放规律。方法选择2017年6月至2018年4月创伤骨科先后进行万古霉素骨水泥链珠及万古霉素人工骨植入术的16例骨感染患者,术中局部埋置引流管,分别于术后2 h及此后每日清晨留取患者静脉血及伤口引流液标本,直至术后引流管拔除,使用酶放大免疫法进行静脉血及引流液万古霉素浓度测定。结果万古霉素骨水泥、人工骨植入术后平均引流量分别为(504.50±306.52)、(278.68±136.18)ml,局部累计释放率为5.60%±3.61%、19.12%±9.86%,最大释放速度为(6.1±4.4)、(20.8±9.5)mg/h,全身血药浓度Cmax为(0.66±0.34)、(1.39±0.98)mg/L。结论万古霉素人工骨和骨水泥植入人体后均能获得很高的局部药物治疗浓度,全身药物浓度很低,安全性较好。人工骨较骨水泥局部药物浓度更高,总体释放量、释放率、释放速度及植入后全身的药物浓度均高于万古霉素骨水泥。

Objective To compare the local release characteristics of vancomycin-loaded bone cement with those of artificial bone by measuring the drug concentration of them in blood and the wound drainage fluid after vancomycin-loaded bone cement and artificial bone implanted in patients with bone infection.Methods The bone infection patients in department of orthopedic trauma were treated with vancomycin bone cement beads and vancomycin artificial bone implantation.The drainage tube was implanted during operation.The patient′s venous blood and wound drainage fluid samples were taken at 2 h after operation and thereafter every morning till the drainage tube was removed.The concentration of vancomycin in the venous blood and drainage fluid was determined by enzyme amplification immunoassay.Results The average drainage volume after operation was(504.50±306.52)ml after bone cement implantation and(278.68±136.18)ml after artificial bone surgery;the local cumulative release rate was 5.60%±3.61% and 19.12%±9.86%;the maximum release rate was(6.1±4.4)mg/h and(20.7±9.5)mg/h;the systemic blood concentration Cmax was(0.66±0.34)mg/L and(1.39±0.98)mg/L.Conclusion Vancomycin artificial bone and bone cement can be implanted into the human body to obtain a high local drug concentration,while the systemic drug concentration is low,and the safety is good.The local drug concentration,total release,release rate and speed,and drug concentration after implantation of vancomycin artificial bone are higher than those of vancomycin bone cement.