Wooten S A, Barbarash R A, Strange C, Sahn S A
Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston 29425.
Chest. 1988 Nov;94(5):960-3. doi: 10.1378/chest.94.5.960.
Seven patients with symptomatic pleural effusions (six) and recurrent pneumothorax (one) underwent attempted pleurodesis using tetracycline. Lidocaine (150 mg), followed immediately by tetracycline (20 mg/kg), was instilled into the pleural space through a chest tube. Venous blood was obtained at 0, 15, 30, 60, and 120 minutes following instillation in order to determine concentrations of lidocaine and tetracycline. The mean peak serum concentration of lidocaine was 1.3 mu/ml +/- 0.4 microgram/ml (mean +/- SE) (range, 0.3 microgram/ml to 3.2 microgram/ml), and the mean time to peak serum concentration of lidocaine was 86 +/- 13 minutes. The mean peak serum concentration of tetracycline was 3.6 microgram/ml +/- 0.9 microgram/ml (range, 1.0 microgram/ml to 5.0 micrograms/ml), and the mean time to peak serum concentration of tetracycline was 96 +/- 16 minutes. Therapeutic serum concentrations of lidocaine were found in four of the seven patients and therapeutic serum levels of tetracycline in four of five patients. With systemic absorption of lidocaine and tetracycline following intrapleural instillation, patients are at risk for potential toxic effects. If lidocaine is used in a dosage of less than 3 mg/kg, toxic levels of the drug are unlikely to occur. Furthermore, use of tetracycline or lidocaine in pleurodesis is contraindicated in patients with known sensitivity to the drugs.
7例有症状性胸腔积液（6例）和复发性气胸（1例）的患者尝试使用四环素进行胸膜固定术。先经胸管向胸腔内注入利多卡因（150mg），随后立即注入四环素（20mg/kg）。在注入后0、15、30、60和120分钟采集静脉血，以测定利多卡因和四环素的浓度。利多卡因的平均血清峰值浓度为1.3μg/ml±0.4μg/ml（平均值±标准误）（范围为0.3μg/ml至3.2μg/ml），利多卡因达到血清峰值浓度的平均时间为86±13分钟。四环素的平均血清峰值浓度为3.6μg/ml±0.9μg/ml（范围为1.0μg/ml至5.0μg/ml），四环素达到血清峰值浓度的平均时间为96±16分钟。7例患者中有4例出现利多卡因的治疗性血清浓度，5例患者中有4例出现四环素的治疗性血清水平。胸膜腔内注入利多卡因和四环素后出现全身吸收，患者有发生潜在毒性作用的风险。如果利多卡因的用量小于3mg/kg，不太可能出现药物的中毒水平。此外，已知对药物敏感的患者禁忌在胸膜固定术中使用四环素或利多卡因。
