静脉输注甘露醇开放血脑屏障对抗生素透过血脑屏障的影响

目的　通过快速静脉输注甘露醇可逆性开放血脑屏障 (BBB) ,探知此方法能否增加抗生素透过BBB的量 ,在何时达到最高峰 ,其通透量增加后临床上有无不良反应。方法　采用自身配伍设计 ,共 6个样本组。对照组仅使用抗生素 ;其余 5组分别在使用甘露醇前 60、3 0min ,同时使用甘露醇后 3 0、60min使用抗生素 ,各组皆取使用抗生素后 1h的脑脊液测其抗生素浓度。抗生素选用头孢三嗪。结果　测量值经过q检验 ,经 2 0 %甘露醇处理前后的CSF中的头孢三嗪浓度差异有非常显著性。全组患者经临床观察未出现神经系统的不良反应。结论　经静脉快速输注2 0 %甘露醇后可以使透过BBB的水溶性抗生素的量增加 ,两者使用的顺序是在抗生素使用 3 0min内即给予甘露醇快速滴注。该方法不会增加低神经毒性抗生素在中枢神经系统的不良反应。

Effect of the opening of the blood-brain barrier with the venous rapid drip of mannitol on the entry of the antibiotics

ObjectiveTo investigate the effect of reversibly opening of the blood brain barrier (BBB) by venous rapid drip of mannitol on the entry of antibiotics.MethodsRandomized block design was adopted.The control group was only dealed with ceftriazone,but the remaining 5 groups were treated with ceftriazone prior to or posterior to 60 min,30 min,0 min,respectively,with intravenous injection of hyperosmotic mannitol.The concentration in cerebrospinal fluid (CSF) was measured in 1 h after administration of ceftriazone.Statistical difference was tested in CSF concentration of ceftriazone with q test.ResultsThere were statistical differences in CSF concentration of ceftriazone among these 6 groups.There was no severe side-effects in CNS through clinical observation.ConclusionEnhanced water-solubility antibiotic delivery to the central nevous system can be attained by osmotic disruption of BBB through intravenous administration of 20% mannitol 250 ml.The sequence that mannitol should be infused intravenously within 30 min posterior to ceftriazone was more effective than others.This measure would not strengthen the side-effects of those hypo-neuro-toxicity antibiotic in CNS.