| 摘要: |
| 目的：探讨第一代头孢菌素预防Ⅰ类切口手术部位感染的既往方案在目前微生物药敏下的预防效果。方法：基于药动学/药效学（PK/PD）理论利用蒙特卡洛模拟法进行探讨。以头孢唑林和头孢噻吩为考察药物，金黄色葡萄球菌、凝固酶阴性葡萄球菌和链球菌属为目标菌群，给药间期内游离药物浓度位于最低抑菌浓度（MIC）之上的时间占一个给药间期的百分比（fT>MIC）为PK/PD靶指数，利用蒙特卡罗模拟头孢唑林和头孢噻吩既往方案对抗目标菌群达到PK/PD靶指数的累积反应分数（CFR）≥90%为标准探讨给药策略及预防效果。结果：对于成人（体质量以60 kg计），头孢唑林仅“1 g，q 2 h”“2 g，q 4 h”“3 g，q 4 h”和“术前1 g；术中0.5 g，q 2 h”的方案，头孢噻吩仅“2 g，q 3 h”和“术前2 g；术中1 g，q 3 h”的方案对各目标菌群的CFR≥90%，两者其他的既往方案均无法达到CFR≥90%标准。结论：应用第一代头孢菌素预防Ⅰ类切口手术部位感染时，应注意选择合适的给药方案（CFR≥90%），以确保预防效果。 |
| 关键词: 药动学/药效学 蒙特卡罗模拟法 Ⅰ类切口 抗菌药物 头孢唑林 头孢噻吩 |
| DOI： |
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| 基金项目: |
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| Evaluation on Administration Regimen of First-Generation Cephalosporins for Prevention of Surgical Site Infection by Monte Carlo Simulation |
| Zhang Yuqin1, Song Xiangqing2 |
| (1. Xiangya Hospital Central South University, Hunan Changsha 410008, China; 2. Hunan Cancer Hospital, Hunan Changsha 410013, China) |
| Abstract: |
| Objective: To explore the preventive effects of the first-generation cephalosporins for the prevention of infection in the surgical site of type Ⅰ incision under current microbial susceptibility. Methods: The Monte Carlo simulation based on the pharmacokinetics/pharmacodynamics (PK/PD) theory was used. Cefazolin and cefotaxime were set as the investigation drugs, Staphylococcus aureus, coagulase-negative Staphylococcus and Streptococcus were set as the targeted flora. The time during which the free drug concentration exceeded the minimum inhibitory concentration (MIC) during the dosing period as a percentage of the dosing interval (fT>MIC) was the PK/PD target index. The Monte Carlo simulation of cefazolin and cefotaxime was used to counter the target group, so as to achieve the cumulative reaction score (CFR) of ≥90% of the PK/PD target index as the standard to discuss the drug delivery strategy and preventive effects. Results: For adults (body mass measured as 60 kg), cefazolin was only “1 g, q 2 h”, “2 g, q 4 h”, “3 g, q 4 h” and “1 g before surgery; 0.5 g during surgery, q 2 h”, cefalotin was only “2 g, q 3 h” and “2 g before surgery, 1 g during surgery, q 3 h”, the CFR≥90% of each target flora could not meet the standard of CFR≥90% in other previous schemes. Conclusion: During application of the first-generation cephalosporins for the prevention of infection in the surgical site of type Ⅰ incision, more importance should be attached to select appropriate dosage regimen (CFR≥90%) to ensure protective effects. |
| Key words: pharmacodynamics/pharmacokinetics Monte Carlo simulation type Ⅰ incision antibiotics cefazolin cefalotin |
