Department of Anesthesiology and Pain Medicine, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, South Korea.
University of Ulsan College of Medicine, Seoul, South Korea.
Br J Clin Pharmacol. 2024 Feb;90(2):582-587. doi: 10.1111/bcp.15943. Epub 2023 Nov 13.
This study aimed to evaluate the predictive performance of previously constructed cefazolin pharmacokinetic models and determine whether cefazolin administration via the target-controlled infusion (TCI) method may be possible in clinical practice.
Twenty-five gastrectomy patients receiving cefazolin as a prophylactic antibiotic were enrolled. Two grams of cefazolin was dissolved in 50 mL of normal saline to give a concentration of 40 mg mL . Before skin incision, cefazolin was administered using a TCI syringe pump, and its administration continued until the end of surgery. The target total plasma concentration was set to 100 μg mL . Total and unbound plasma concentrations of cefazolin were measured in three arterial blood samples collected at 30, 60 and 120 min after the start of cefazolin administration. The predictive performance of the TCI system was evaluated using four measures: inaccuracy, divergence, bias and wobble.
Total (n = 75) and unbound (n = 75) plasma concentration measurements from 25 patients were included in the analysis. The pooled median (95% confidence interval) biases and inaccuracies were 6.3 (4.0-8.5) and 10.5 (8.6-12.4) for the total concentration model and -10.3 (-16.8 to -3.7) and 22.4 (18.2-26.7) for the unbound concentration model, respectively. All unbound concentrations were above 10 μg mL .
Administration of cefazolin by the TCI method showed a clinically acceptable performance. Applying the TCI method by setting the total concentration as the target concentration rather than the unbound concentration is effective in maintaining a constant target concentration of cefazolin.
本研究旨在评估先前构建的头孢唑林药代动力学模型的预测性能，并确定是否可以在临床实践中通过靶控输注（TCI）方法给予头孢唑林。
纳入 25 例接受头孢唑林作为预防性抗生素的胃切除术患者。将 2 克头孢唑林溶解在 50 毫升生理盐水中，得到 40 毫克/毫升的浓度。在皮肤切开前，使用 TCI 注射器泵给予头孢唑林，持续给药直至手术结束。目标总血浆浓度设定为 100μg/ml。在头孢唑林给药开始后 30、60 和 120 分钟采集 3 份动脉血样，测量头孢唑林的总血浆和游离血浆浓度。使用 4 种措施评估 TCI 系统的预测性能：不准确性、发散性、偏差和摆动。
对 25 例患者的 75 次总（n=75）和 75 次游离（n=75）血浆浓度测量值进行了分析。总浓度模型和游离浓度模型的平均（95%置信区间）偏倚和不准确性分别为 6.3（4.0-8.5）和 10.5（8.6-12.4），以及-10.3（-16.8 至-3.7）和 22.4（18.2-26.7）。所有游离浓度均高于 10μg/ml。
通过 TCI 方法给予头孢唑林的方法显示出临床可接受的性能。通过将总浓度设定为目标浓度而不是游离浓度来应用 TCI 方法，可有效维持头孢唑林的恒定目标浓度。
