美罗培南静脉持续泵入时血液和脑脊液药物浓度的测定

目的探讨静脉持续注射美罗培南后血清和脑脊液药物代谢动力学的变化规律。方法选择开颅术后保留脑室引流的患者8例。于手术后6h内静脉持续注射美罗培南,给药方案为开始30min持续静脉泵入美罗培南0.5g,随后24h持续静脉泵入美罗培南3.0g。分别于给药前即刻,给药后10、20和30min、1、2、3、4、6、8、10、12和24h采集静脉血和脑脊液标本,用高效液相色谱法测定美罗培南浓度。结果美罗培南的血清峰浓度为(63.72±22.08)mg/L,达峰时间为30min,静脉持续注射3h后达到稳态,血清浓度为(21.44±3.36)mg/L。脑脊液美罗培南的峰浓度为(3.97±0.45)mg/L,达峰时间为3h,静脉持续注射6h后达到稳态,脑脊液浓度为(2.65±0.06)mg/L。美罗培南血清和脑脊液稳态药物浓度达到并超过颅内感染常见细菌的90%最小抑菌浓度。结论采用静脉持续注射的方法给予美罗培南能够早期达到有效的稳态药物浓度。

Determination of Concentration of Meropenem in Serum and Cerebrospinal Fluid during Continuous Intravenous Infusion

Objective To evaluate the pharmacokinetics of meropenem in serum and cerebrospinal fluid(CSF).Methods Eight post-craniostomy patients with ventricular drainage were enrolled in this study. Meropenem was infused intravenously after operation with 0.5 g continuously in the first 30 min and then 3.0 g continuously in the 24 h thereafter. Venous blood and CSF specimens were collected before, and 10, 20, 30 min, 1, 2, 3, 4, 6, 8, 10, 12 and 24 h after medication. Meropenem concentration in specimens were measured by high performance liquid chromatography.Results The peak meropenem concentrations in serum and CSF were (63.72±22.08)mg/L and (3.97±0.45)mg/L, respectively. The peak concentrations occurred at 30 min in serum and 3 h in CSF after medication. The respective steady state concentrations of meropenem in serum (21.44±3.36)mg/L and in CSF (2.65±0.06)mg/L were achieved in 3 h and 6 h after medication, which exceeded the 90% minimum inhibitory concentration of common pathogens in intracranial infection.Conclusion Results of the present study indicate that steady state concentration of meropenem is achieved early by continuously intravenous infusion.