脑脊液与血清利奈唑胺浓度监测指导颅内感染临床治疗的价值

Clinical value of cerebrospinal fluid and serum linezolid concentration monitoring guided treatment in intracranial infection

目的监测神经外科手术后颅内感染患者应用利奈唑胺抗感染治疗时脑脊液利奈唑胺药物浓度及血脑屏障通透率,指导利奈唑胺临床应用。方法选取2019年6月至2019年11月入住青岛大学附属医院神经外科监护室的颅脑术后感染患者6例,静脉应用利奈唑胺抗感染治疗。连续监测患者脑脊液及血液利奈唑胺浓度、脑脊液常规、脑脊液生化及一般生命体征,分析利奈唑胺血脑屏障通透率。结果利奈唑胺给药前0.5 h的血清和脑脊液药物谷浓度分别为(4.65±2.72)μg/ml和(3.78±1.53)μg/ml。在开始用药后2 h,血清中利奈唑胺的最大平均浓度为(12.53±3.79)μg/ml,而脑脊液中最大平均浓度为(5.55±2.00)μg/ml。脑脊液利奈唑胺曲线下面积/血清曲线下面积约为45%。所有患者应用利奈唑胺抗感染治疗后,颅内感染均得到治愈。结论利奈唑胺具有满意的血脑屏障通透率,临床治疗效果良好。静脉应用利奈唑胺脑脊液浓度个体间差异大,推荐临床监测脑脊液浓度指导应用。

Objective To monitor the cerebrospinal fluid(CSF)concentration of linezolid and its blood-brain barrier(BBB)penetration rate in patients with intracranial infection after neurosurgery.Methods A total of six patients admitted to the neurosurgical intensive care unit with post-neurosurgery infection between June 2019 and November 2019 were selected.The CSF and serum linezolid concentrations,routine CSF test,CSF biochemistry test,and general vital signs were continuously monitored to analyze the BBB permeability rate of linezolid.Results The serum and CSF trough concentrations of intravenous linezolid were(4.65±2.72)μg/ml and(3.78±1.53)μg/ml,respectively,at 0.5 h before linezolid administration.The maximum mean serum concentration was(12.53±3.79)μg/ml,while the maximum mean CSF concentration was(5.55±2.00)μg/ml at 2 h after initiation of linezolid administrations.Intravenous linezolid AUCCSF/AUCserum was approximately 45%.All patients treated with linezolid were cured of intracranial infection.Conclusion Intravenous linezolid has a satisfactory BBB penetration rate of about 45%,and it has a good clinical effect.After intravenous application of linezolid,CSF concentrations vary greatly between individuals,so clinical monitoring of CSF concentrations is recommended for guiding its application.