部分抗生素在急性梗阻性化脓性胆管炎患者胆汁中代谢特点及意义

目的探讨部分头孢菌素及喹诺酮类抗生素在急性梗阻化脓性胆管炎患者（ACST）胆汁中的代谢特点，为临床抗胆道感染合理用药提供实验依据。方法通过临床行逆行胰胆管造影＋鼻胆管（ERCP＋ENBD）引流直接获取胆汁，分别给予头孢拉啶、头孢哌酮钠、头孢曲松钠、环丙沙星、洛美沙星，利用高效液相色谱法动态监测胆汁中各种抗生素的浓度变化和代谢特点。结果（1）头孢菌素类以头孢曲松组达峰时间短、达峰浓度高，头孢哌酮组次之，头孢哌酮组半衰期长，头孢曲松组次之；（2）喹诺酮类以环丙沙星达峰时间短、达峰浓度高、半衰期长。结论头孢曲松及环丙沙星均具有在ACST患者胆汁内达峰时间短、峰浓度高、半衰期长的特点，药物代谢动力学特点利于抗胆道感染，可结合临床细菌培养及药敏结果可作为胆道感染的最佳抗生素选择。对重症患者可增加给药次数，提高疗效。

Metabolize characteristic and effects of cephalosporins and fluoroquinolones in ACST in human bile

Objective To investigate the regulation of metabolize characteristic of some antibiotics in ACST in human bile, and provide the theoretic basis for physician selecting antibiotic rationally when biliary tract has been infected. Methods Samples of ACST in human bile were obtained by ERCP + ENBD, contents of Cefradine, Cefoperazone, Ceftriaxone, Ciprofloxacin and Lomefloxacin in human bile were simultaneously measured by HPLC method. Results After antibiotics were given through iv 0. 25 ～ 1. 5 hour, an increase was observed in contents of all antibiotics in bile, and the changes of Ceftriaxone and Ciprofloxa-cin were the most significant ( P <0.01). Ceftriaxone and Ciprofloxacin had a higher Cmax than other antibiotics, and Cefoperazone had a longer tl/2. Conclusion As maintaining a little time to tmax , a higher Cmax and a longer tl/2 in the bile by iv, Cefradine and Ciprofloxacin are recommended in the patient with ACST.