Wang Qiang, Shi Zhonghua, Wang Jiangfei, Shi Guangzhi, Wang Shuo, Zhou Jianxin
ICU, Beijing Tiantan Hospital, The Capital Medical University, Beijing 100050, China.
Surg Neurol. 2008 Feb;69(2):126-9; discussion 129. doi: 10.1016/j.surneu.2007.01.073. Epub 2007 Oct 31.
The purpose of this study was to investigate whether vancomycin CSF concentration can reach therapeutic level when administered intravenously after neurosurgical operation.
After patients were admitted to the ICU, vancomycin (1.0 g) was injected intravenously, and CSF was collected from either ventricular drainage (VD group, n = 9) or LPD (LPD group, n = 10). The CSF concentration of vancomycin was measured using HPLC.
Peak concentration occurred at 15 to 30 minutes after venoclysis (6.24 +/- 3.46 mg/L in the VD group and 4.49 +/- 3.14 mg/L in the LPD group, respectively) and reached or even exceeded the MIC(90) for MRSA (2 mg/L) and MRCoNS (2 mg/L). Twelve hours later, CSF vancomycin concentration in the VD and LPD groups was 2.55 +/- 1.13 and 2.43 +/- 0.41 mg/L, respectively.
Neurosurgical operation may disrupt the integrality of BBB so that vancomycin can penetrate through the BBB easily and reach therapeutic concentration of CSF when administered intravenously after operation. This finding suggests that vancomycin can be administered intravenously when used to treat intracranial infection after neurosugical operation.
本研究旨在探讨神经外科手术后静脉应用万古霉素时脑脊液浓度能否达到治疗水平。
患者入住重症监护病房后，静脉注射万古霉素（1.0 g），并从脑室引流（VD组，n = 9）或腰椎穿刺引流（LPD组，n = 10）采集脑脊液。采用高效液相色谱法测定脑脊液中万古霉素的浓度。
静脉滴注后15至30分钟出现峰值浓度（VD组为6.24±3.46 mg/L，LPD组为4.49±3.14 mg/L），达到甚至超过耐甲氧西林金黄色葡萄球菌（MRSA）和耐甲氧西林凝固酶阴性葡萄球菌（MRCoNS）的MIC90（2 mg/L）。12小时后，VD组和LPD组脑脊液万古霉素浓度分别为2.55±1.13和2.43±0.41 mg/L。
神经外科手术可能破坏血脑屏障的完整性，使得术后静脉应用万古霉素时能够轻易透过血脑屏障并达到脑脊液治疗浓度。这一发现提示，万古霉素用于治疗神经外科术后颅内感染时可采用静脉给药方式。
