肥胖对剖宫产术前预防性应用头孢唑林组织浓度的影响

目的：评估肥胖妇女剖宫产术前静脉滴注头孢唑林的抗微生物活性。方法：依据身体质量指数（BMI），将46名行剖宫产术的肥胖患者分为轻度肥胖、中度肥胖、和重度肥胖三组，术前30—60min内，给予所有患者2g头孢唑林，分别采集开腹后和关腹前的脂肪组织、子宫肌层组织和血清样本。应用微生物琼脂扩散法，分别分析采集样本的抗生素浓度。结果：（1）皮肤切口脂肪组织的头孢唑林浓度与母体的身体质量指数成负相关（r=0．66，P〈0．001）。（2）中度肥胖组与轻度肥胖组头孢唑林平均浓度比较，差异有统计学意义（P〈0．01）；重度肥胖组与轻度肥胖组孢唑林平均浓度相比较，差异有统计学意义（P〈0．001）。（3）部分中度肥胖和重度肥胖患者开腹后和关腹前其脂肪组织的头孢唑林浓度未达到革兰氏阴性杆菌最小抑菌浓度（C≥4μg／g）。结论：药代动力学分析表明，对于肥胖妇女的剖宫产术，目前预防性应用抗生素的剂量不能达到有效抗微生物浓度。

Influence of Maternal Obesity on Tissue Concentrations of Prophylactic Cefazolin During Cesarean Delivery

Objective： To estimate the adequacy of antimicrobial activity of preoperative antibiotics at the time of cesarean delivery as a function of maternal obesity. Method： Forty-six patients scheduled for cesarean delivery were stratified according to body mass index （ BMI ） category, with lean, obese, and extremely obese. All patients were given a close of 2 g cefazolin 30-60 minutes before skin incision. Antibiotic concentrations were analyzed with microbiological agar diffusion assay. Result： （ 1 ） Cefazolin concentrations within adipose tissue obtained at skin incision was inversely proportional to maternal BMI （ r=-0.66, P〈0.001 ） . （ 2 ） The mean adipose concentration in the lean group of women compared in the obese group （ P〈0.01 ） and compared in the extremely obese group （ P〈0.001 ） . （ 3 ） A considerable portion of obese and extremely obese did not achieve minimal inhibitory concentrations of greater than 4 micrograms/g for Gram-negative rods in adipose samples at skin incision or closure. Conclusion： Pharmacoklnetie analysis suggests that present antibiotic prophylaxis dosing may fail to provide adequate antimierebial coverage in obese patients during cesarean delivery.