Badia J M, de la Torre R, Farré M, Gaya R, Martínez-Ródenas F, Sancho J J, Sitges-Serra A
Department of Surgery, Hospital Universitari del Mar, Barcelona, Spain.
Br J Surg. 1995 Apr;82(4):479-82. doi: 10.1002/bjs.1800820417.
The efficacy of antibiotic prophylaxis depends on appropriate tissue levels of the drug being present at the time of potential wound contamination. Metronidazole concentrations in serum, muscle and subcutaneous fat were measured after a single intravenous dose given at two different intervals before operation. Twenty-six patients undergoing abdominal wall procedures were divided into two groups. Patients in group 1 received metronidazole 500 mg intravenously 2 h before surgery, and those in group 2 were given the drug during induction of anaesthesia. Mean plasma levels of metronidazole at the beginning of the procedure were significantly lower (P = 0.01) in group 1 (7.3 (95 per cent confidence interval 5.7-8.9)) micrograms/ml than in group 2 (12.3 (8.9-15.7)) micrograms/ml although in both cases were above the minimum inhibitory concentration for 90 per cent of Bacteroides fragilis. Similar therapeutic concentrations of metronidazole were achieved in plasma and muscle in both groups at the end of the operation. However, patients in both groups had non-therapeutic concentrations of metronidazole in subcutaneous fat: group 1 0.9 (0.6-1.2) micrograms/mg, group 2 1.2 (0.7-1.7) micrograms/mg at the beginning of operation, and 1.2 (0.8-1.6) and 1.5 (0.9-2.1) micrograms/mg respectively at the end of the procedure. It is concluded that infusion of metronidazole 2 h before surgery or during induction of anaesthesia achieved adequate plasma and muscle levels but failed to achieve therapeutic levels in subcutaneous fat.
抗生素预防性治疗的效果取决于在潜在伤口污染发生时药物在组织中达到适当的水平。在手术前两个不同时间间隔给予单次静脉注射后，测定血清、肌肉和皮下脂肪中的甲硝唑浓度。26例行腹壁手术的患者被分为两组。第一组患者在手术前2小时静脉注射500毫克甲硝唑，第二组患者在麻醉诱导期间给予该药物。在手术开始时，第一组（7.3（95%置信区间5.7 - 8.9））微克/毫升的甲硝唑平均血浆水平显著低于（P = 0.01）第二组（12.3（8.9 - 15.7））微克/毫升，尽管在两种情况下均高于脆弱拟杆菌90%的最低抑菌浓度。两组患者在手术结束时血浆和肌肉中均达到了相似的甲硝唑治疗浓度。然而，两组患者皮下脂肪中的甲硝唑浓度均未达到治疗水平：手术开始时，第一组为0.9（0.6 - 1.2）微克/毫克，第二组为1.2（0.7 - 1.7）微克/毫克；手术结束时，分别为1.2（0.8 - 1.6）微克/毫克和1.5（0.9 - 2.1）微克/毫克。结论是，手术前2小时或麻醉诱导期间输注甲硝唑可使血浆和肌肉达到足够水平，但皮下脂肪中未能达到治疗水平。
