Pojar Marek, Mandak Jiri, Malakova Jana, Jokesova Iveta
Department of Cardiac Surgery, Charles University in Prague, Faculty of Medicine, University Hospital in Hradec Králové, Czech Republic.
Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2008 Jun;152(1):139-45. doi: 10.5507/bp.2008.022.
Surgical-site infections are very serious complications of cardiac operations. Use of cardiopulmonary bypass (CPB) is associated with profound physiological changes, which affects the pharmacokinetic behaviour of prophylactic antibiotics. The aim of this study was to monitor tissue concentrations of cefuroxime in peripheral tissue (skeletal muscle) during cardiac surgery using CPB by means of a microdialysis.
Eleven adult patients operated on using CPB were included in the study. Cefuroxime was the prophylactic antibiotic and study drug given. Microdialysis was performed by probe CMA 60 inserted into the patient's left deltoid muscle. Samples of dialysates were collected at intervals: before CPB, each 30 minutes of CPB and at the end of CPB. Samples of blood were collected at intervals: incision, start of CPB, each 30 minutes of CPB, at the end of CPB and at the end of surgery.
The mean (+/- S.D.) concentrations of cefuroxime in peripheral tissue were 105.4+/-41.1, 81.7+/-32.8, 74.6+/-26.0, 70.4+/-34.7, 60.5+/-27.2, 138.0+/-42.6 (mg l(-1)). Total plasma concentrations of cefuroxime were 154.4+/-41.6, 73.3+/-20.7, 67.1+/-20.4, 59.2+/-21.0, 49.0+/-16.4, 110.9+/-33.6 (mg l(-1)) and concentrations of free plasma fraction were 110.7+/-37.1, 62.2+/-18.8, 58.9+/-18.6, 48.4+/-16.6, 41.7+/-15.6, 97.6+/-28.6 (mg l(-1)). The plasma and tissue concentrations exceed throughout the operation time the minimum inhibitory concentration for most common suspected pathogens in cardiac surgery.
Results show that CPB can modify the time course of cefuroxime tissue and plasma concentrations. Microdialysis is suitable for antibiotic tissue measurement in cardiac surgery.
手术部位感染是心脏手术非常严重的并发症。使用体外循环（CPB）会伴随深刻的生理变化，这会影响预防性抗生素的药代动力学行为。本研究的目的是通过微透析监测心脏手术期间使用CPB时头孢呋辛在周围组织（骨骼肌）中的组织浓度。
11例接受CPB手术的成年患者纳入本研究。头孢呋辛是预防性抗生素及研究用药。通过插入患者左三角肌的CMA 60探针进行微透析。透析液样本在CPB前、CPB期间每30分钟以及CPB结束时采集。血液样本在切口时、CPB开始时、CPB期间每30分钟、CPB结束时以及手术结束时采集。
头孢呋辛在周围组织中的平均（±标准差）浓度分别为105.4±41.1、81.7±32.8、74.6±26.0、70.4±34.7、60.5±27.2、138.0±42.6（mg l⁻¹）。头孢呋辛的血浆总浓度分别为154.4±41.6、73.3±20.7、67.1±20.4、59.2±21.0、49.0±16.4、110.9±33.6（mg l⁻¹），血浆游离部分浓度分别为110.7±37.1、62.2±18.8、58.9±18.6、48.4±16.6、41.7±15.6、97.6±28.6（mg l⁻¹）。在整个手术过程中，血浆和组织浓度均超过心脏手术中最常见可疑病原体的最低抑菌浓度。
结果表明CPB可改变头孢呋辛组织和血浆浓度的时间进程。微透析适用于心脏手术中抗生素组织浓度的测定。
