Limthongkul S
Department of Medicine, Chulalongkorn University, Bangkok, Thailand.
J Med Assoc Thai. 1991 Apr;74(4):224-9.
Studies were conducted on three consecutive patients with parapneumonic effusions by (a) serial analyses of plasma -pleural fluid glucose, pH, PCO2, and antimicrobial levels, and (b) serial analyses to determine the pH and PCO2 levels of pleural fluids that underwent in vitro incubation, before and after antimicrobial administration. The pleural fluid pharmacokinetics of the three antimicrobials followed a large reservoir model by increasing drug levels gradually, reaching the peak values at about two to seven hours following administration, while serial pleural fluid glucose levels showed a delayed rise or no rise in concentration, respectively. The molecular weights of the three antimicrobials are greater than that of the glucose, thus suggesting that over-utilization of glucose within the pleural cavity is more likely the cause of this situation than the transport defect. In the in vitro incubation study, the serial pleural fluid pH and PCO2 levels before antimicrobial administration progressively decreased, while those following the administration of antimicrobials were stable during the first few hours. The results indicate that, in cases of parapneumonic effusion, the inflamed pleurae and the infectious pleural fluid (empyema) over-utilizes pleural fluid glucose leading to increased fluid acidity.
对三名连续患有类肺炎性胸腔积液的患者进行了研究，方法如下：(a) 对血浆-胸腔积液的葡萄糖、pH值、二氧化碳分压（PCO2）和抗菌药物水平进行系列分析；(b) 对接受体外培养的胸腔积液在给予抗菌药物前后的pH值和PCO2水平进行系列分析。三种抗菌药物的胸腔积液药代动力学遵循大储存库模型，药物水平逐渐升高，给药后约两至七小时达到峰值，而系列胸腔积液葡萄糖水平分别显示浓度延迟升高或未升高。三种抗菌药物的分子量均大于葡萄糖，因此表明胸腔内葡萄糖的过度利用比转运缺陷更可能是导致这种情况的原因。在体外培养研究中，给予抗菌药物前系列胸腔积液的pH值和PCO2水平逐渐降低，而给予抗菌药物后的最初几个小时内这些指标保持稳定。结果表明，在类肺炎性胸腔积液病例中，发炎的胸膜和感染性胸腔积液（脓胸）过度利用胸腔积液葡萄糖，导致液体酸度增加。
