Matthys H, Herceg R
Abteilung Pneumologie, Medizinische Universitätsklinik Freiburg.
Med Klin (Munich). 1990 Apr;85 Suppl 2:251-4.
Intracorporal, especially pulmonary, and extracorporal deposition of pentamidine was studied following inhalation of 300 or 600 mg in 6 ml Aqua dest. each dose in six patients with one previous episode of pneumocystis carinii pneumonia. Three different nebulizers--two mechanical nebulizers (Respirgard II and Pari-IS-2) and one ultrasonic device (Portasonic) - were compared. The following results were obtained: 1.300 mg pentamidine in 6 ml Aqua dest. is a sufficient dose for prophylaxis provided an appropriately constructed nebulizer and an optimal respiratory manoeuvre (inspiratory vital capacity breathing) are employed. With the nebulizer Portasonic, the frequency of cough was higher compared with the two mechanical nebulizers, which is attributed to its higher mist density. 2. Application of 600 mg pentamidine in 6 ml Aqua dest. as an aerosol is difficult to apply owing to clinical and technical problems caused by severe respiratory tract irritation and a high viscosity of the nebulizer solution. We assume that ultrasonic nebulization is affected more by the high viscosity than mechanical pneumatic nebulization. 3. Inspiratory vital capacity breathing (12/min) leads to five- to eight-fold higher pulmonary and improved peripheral deposition rates compared with commonly used spontaneous respiration. We therefore recommend to shorten the duration of inhalation by applying this respiratory technique while maintaining a generally tolerated and optimally nebulizable concentration of pentamidine, i.e. about 300 mg in 6 ml Aqua dest.
在6名曾患过卡氏肺孢子虫肺炎的患者中,吸入6毫升注射用水中含300毫克或600毫克的喷他脒后,对体内尤其是肺部以及体外的喷他脒沉积情况进行了研究。比较了三种不同的雾化器——两种机械雾化器(Respirgard II和Pari - IS - 2)和一种超声设备(Portasonic)。得到以下结果:1. 如果使用构造合适的雾化器并采用最佳呼吸动作(吸气肺活量呼吸),6毫升注射用水中含300毫克喷他脒是足够的预防剂量。与两种机械雾化器相比,使用Portasonic雾化器时咳嗽频率更高,这归因于其更高的雾滴密度。2. 6毫升注射用水中含600毫克喷他脒作为气雾剂应用困难,这是由于严重的呼吸道刺激和雾化器溶液的高粘度所导致的临床和技术问题。我们认为超声雾化比机械气动雾化受高粘度的影响更大。3. 与常用的自主呼吸相比,吸气肺活量呼吸(每分钟12次)可使肺部沉积率提高五到八倍,并改善外周沉积率。因此,我们建议采用这种呼吸技术缩短吸入时间,同时保持喷他脒的一般耐受且最佳雾化浓度,即6毫升注射用水中约含300毫克。