Discipline of Anaesthesiology, Heart Institute of the University of São Paulo Medical School, São Paulo, Brazil.
Eur J Cardiothorac Surg. 2012 Aug;42(2):300-5. doi: 10.1093/ejcts/ezr319. Epub 2012 Jan 26.
The aims of this study were to evaluate the influence of cardiopulmonary bypass (CPB) on the plasma concentrations and pharmacokinetics of cefuroxime and to assess whether the cefuroxime dose regimen (a 1.5 g dose, followed by 750 mg every 6 h for 24 h) is adequate for cardiac surgery antibiotic prophylaxis.
A prospective, controlled, observational study compared patients undergoing coronary surgery with CPB (CPB group, n = 10) or off-pump surgery (off-pump group, n = 9). After each cefuroxime dose, blood samples were sequentially collected and analysed using high-efficiency chromatography. For demographic data and pharmacokinetic parameters, the authors used Fisher's exact test for nominal variables and Student's t-test and the Mann-Whitney U-test for parametric and non-parametric variables, respectively. Plasma concentrations were compared using ANOVA, and the percentage of patients with a remaining plasma concentration of >16 mg/l within 6 h after each bolus was quantified in tabular form.
After each cefuroxime bolus was administered, both groups presented a significant decrease in plasma concentration over time (P < 0.001), without differences between the groups. The mean CPB time of 59.7 ± 21.1 min did not change cefuroxime plasma concentrations or pharmacokinetics. The mean clearance ± SD (ml/kg/min) and median elimination half-life (h) of the CPB group versus the off-pump group were 1.7 ± 0.7 versus 1.6 ± 0.6 (P = 0.67), respectively, and 2.2 versus 2.3 (P = 0.49), respectively. Up to 3 h following the first bolus of 1.5 g, but not after 6 h, all patients had plasma concentrations >16 mg/l (CPB group = 20% and off-pump group = 44%). However, after all 750 mg boluses were administered, concentrations <16 mg/dl were reached within 3 h.
CPB does not influence cefuroxime plasma concentrations. The dosing regimen is adequate for the intraoperative period, but in the immediate postoperative period, it requires further review.
本研究旨在评估体外循环（CPB）对头孢呋辛血浆浓度和药代动力学的影响，并评估头孢呋辛剂量方案（1.5 g 剂量，随后每 6 小时给予 750 mg，持续 24 小时）是否适用于心脏手术的抗生素预防。
一项前瞻性、对照、观察性研究比较了接受 CPB 心脏手术的患者（CPB 组，n = 10）和非体外循环心脏手术的患者（非体外循环组，n = 9）。在每次头孢呋辛给药后，连续采集血样，并使用高效液相色谱法进行分析。对于人口统计学数据和药代动力学参数，作者使用 Fisher 确切检验用于名义变量，Student's t 检验和 Mann-Whitney U 检验分别用于参数和非参数变量。使用方差分析比较血浆浓度，并以表格形式量化每个推注后 6 小时内仍有>16 mg/l 血浆浓度的患者比例。
在每次头孢呋辛推注后，两组的血浆浓度均随时间显著下降（P < 0.001），两组之间无差异。59.7±21.1 分钟的平均 CPB 时间并未改变头孢呋辛的血浆浓度或药代动力学。CPB 组与非体外循环组的平均清除率±SD（ml/kg/min）和中位数消除半衰期（h）分别为 1.7±0.7 与 1.6±0.6（P = 0.67）和 2.2 与 2.3（P = 0.49）。在首次 1.5 g 推注后 3 小时内，但不是在 6 小时后，所有患者的血浆浓度均>16 mg/l（CPB 组=20%，非体外循环组=44%）。然而，在所有 750 mg 推注后 3 小时内，浓度均<16 mg/dl。
CPB 不影响头孢呋辛的血浆浓度。该剂量方案适用于手术期间，但在术后即刻，需要进一步审查。
