去甲万古霉素介入治疗慢性骨髓炎的实验研究

目的观察去甲万古霉素动脉灌注治疗慢性骨髓炎动物的疗效。方法将40只新西兰大白兔于右胫骨近端开骨窗,注入金黄色葡萄球菌及鱼肝油酸钠,骨蜡封闭骨窗,复制出慢性骨髓炎动物模型,随机分为2组,治疗组给予去甲万古霉素200 mg/kg动脉灌注,对照组予静脉推注,于用药后0.5、1、2、4、6、8和12 h采用微生物法测定血液、病灶周围软组织和病灶炎性骨段的去甲万古霉素浓度。结果治疗组炎性骨的去甲万古霉素浓度在用药后0.5、1和2 h明显高于对照组（P〈0.01）,在用药后4 h高于对照组（P〈0.05）;治疗组病灶周围软组织去甲万古霉素浓度在用药后0.5、1和2 h明显高于对照组（P〈0.01）,在用药后4、6 h高于对照组（P〈0.05）;血液中则相反,治疗组去甲万古霉素浓度在用药后0.5、1和2 h明显低于对照组（P〈0.01）,在用药后4 h低于对照组（P〈0.05）。结论术前4 h内经骨髓炎骨段供血动脉插管灌注去甲万古霉素,能保证慢性骨髓炎清除术术野有较高的抗生素浓度。

Experimental study of norvancomycin intervention in the treatment of chronic osteomyelitis

Objective To investigate the therapeutic efficacy of norvancomycin perfusion via artery puncture in the treatment of chronic osteomyelitis in the animal model.Methods 40 New Zealand white rabbits were adopted,and Staphylococcus aureus and sodium morrhuate was infused into a bone window opened at proximal tibia,followed by window sealing by bone wax to copy the animal model of chronic osteomyelitis.The rabbits were randomized into two groups： treatment group received artery perfusion of norvancomycin,while the control group underwent intravenous infusion of norvancomycin.The norvancomycin concentrations in the blood,soft tissues around the lesion and bone fragment were determined at 0.5,1,2,4,6,8 and 12 h using standard agar diffusion assay.Results The concentration of norvancomycin in the inflammatory bone fragment was significantly higher in the treatment group than in the control group at 0.5,1 and 2 h after administration（P0.01） and was even higher at 4 h（P0.05）;the norvancomycin concentration in inflammatory soft tissues was higher in the treatment group than in the control group at 0.5,1 and 2 h after administration（P0.01） and it remained at a higher level at 4 and 6 h（P0.05）;whereas the blood norvancomycin concentration was markedly lower in the treatment group than in the control group at the same time points（P0.01 or P0.05）.Conclusion Preoperative artery perfusion of norvancomycin within 4 h via the artery intubation to the lesion can maintain sufficient drug concentration in the surgical field of debridement for chronic osteomyelitis.