Livingston D H, Wang M T
Department of Surgery, University of Medicine and Dentistry-New Jersey Medical School, Newark.
Am J Surg. 1993 Feb;165(2):203-7. doi: 10.1016/s0002-9610(05)80507-0.
Standard doses of antibiotic administered by intermittent infusions after hemorrhagic shock have decreased efficacy in combating infection. This study compared identical quantities of cefazolin administered after shock as intermittent doses or as continuous infusions in a subcutaneous abscess model. One hour after resuscitation from shock, rats were inoculated with 2 x 10(8) Staphylococcus aureus subcutaneously on the dorsum and divided into three groups: (1) control rats, which received no drug treatment; (2) rats in the intermittent group, which received cefazolin at either 30 or 60 mg/kg intraperitoneally, 30 minutes prior to inoculation, then every 8 hours for three doses, and (3) rats in the continuous infusion group, which received cefazolin at either 30 or 60 mg/kg intraperitoneally, 30 minutes prior to inoculation, followed by cefazolin, 90 or 180 mg/kg, intraperitoneally by continuous infusion more than 24 hours after inoculation. Seven days after the inoculation, abscess number, diameter, and weight were measured. Rats that received either dosage of cefazolin intermittently had the same abscess rate after shock as control rats. Rats that received a continuous infusion of cefazolin at either dose had 56% fewer abscesses than control rats. Abscess diameter and weight decreased with increasing quantities of cefazolin, and abscesses were always smaller in rats receiving the continuous infusion. There were no differences in peak subcutaneous cefazolin levels between the intermittent and continuous groups. Continuous infusion provided significantly more cefazolin to the tissue than an equivalent quantity of cefazolin delivered as intermittent doses. These data demonstrate that continuous infusion of cefazolin provided more antibiotic to the tissue and was superior to intermittent injection in reducing infection after hemorrhagic shock.
失血性休克后通过间歇性输注给予的标准剂量抗生素在对抗感染方面疗效降低。本研究在皮下脓肿模型中比较了休克后以间歇性剂量或持续输注方式给予相同量头孢唑林的情况。休克复苏1小时后，将大鼠背部皮下接种2×10⁸金黄色葡萄球菌，并分为三组：（1）未接受药物治疗的对照大鼠；（2）间歇性给药组大鼠，在接种前30分钟腹腔内给予30或60mg/kg头孢唑林，然后每8小时给药一次，共给药三次；（3）持续输注组大鼠，在接种前30分钟腹腔内给予30或60mg/kg头孢唑林，接种后24小时以上腹腔内持续输注90或180mg/kg头孢唑林。接种7天后，测量脓肿数量、直径和重量。间歇性接受任一剂量头孢唑林的大鼠休克后的脓肿发生率与对照大鼠相同。接受任一剂量头孢唑林持续输注的大鼠脓肿数量比对照大鼠少56%。脓肿直径和重量随头孢唑林量的增加而减小，接受持续输注的大鼠脓肿始终较小。间歇性给药组和持续输注组之间皮下头孢唑林峰值水平无差异。持续输注比等量间歇性给药向组织提供了显著更多的头孢唑林。这些数据表明，持续输注头孢唑林能向组织提供更多抗生素，在减少失血性休克后的感染方面优于间歇性注射。
