摘要目的 测定结核性胸膜炎患者口服联合经胸壁超声导入利福平后胸腔积液中利福平浓度的变化.方法 采用自身前后对照方法.收集2016年9月至2018年1月在遵义医学院附属医院呼吸二科结核病区住院治疗的32例结核性胸膜炎患者,其中男20例,女12例,年龄16～65岁,平均(36±16)岁.根据患者体重给予口服异烟肼0.3～0.4 g/d、利福平0.45～0.60 g/d、乙胺丁醇0.75 g/d及吡嗪酰胺1.0～1.5 g/d抗结核治疗5 d后,经胸壁超声导入利福平3 ml;在超声导入利福平后0、0.5、1、2、4和8 h时分别抽取5 ml胸腔积液,用高效液相色谱法检测导入前后胸腔积液中利福平浓度的变化.采用SPSS 20.0统计软件进行数据分析,计量资料以xˉ±s表示,采用t检验,P<0.05为差异有统计学意义.结果 单纯口服药物5 d后,胸腔积液中利福平的浓度为(2.2±1.1)μg/ml.导入药物后0.5、1、2、4及8 h的利福平浓度分别为(2.7±1.1)、(3.0±1.4)、(3.2±1.2)、(2.8±1.2)和(1.3±1.1)μg/ml,并维持5 h左右.结论 经胸壁超声导入利福平可提高结核性胸膜炎患者胸腔积液中利福平的浓度,与口服药物联合可延长胸腔积液中药物的有效浓度,有利于利福平发挥杀菌作用.

abstractsObjective To investigate the changes of rifampin concentrations in pleural effusion before and after combination treatment with oral and pleural administration of rifampicin by electro-phonophoresis(EP). Methods A self-control study was performed in 32 cases of tuberculous pleurisy treated in the Second Department of Respiratory Medicine of Affiliated Hospital of Zunyi Medical College between September 2016 and January 2018. Based on the weight of each patient, an oral administration of isoniazid (0.3-0.4 g/d), rifampicin (0.45-0.60 g/d),ethambutol(0.75 g/d),and pyrazinamide (1.0-1.5 g/d) were given. After a 5-day traditional anti-tuberculosis treatment, an additional EP treatment was applied by penetrating chest wall to deliver 3 ml of rifampicin. The concentration of rifampicin in 5 ml pleural effusion was measured at 0, 0.5, 1, 2, 4 and 8h after applying EP treatment using high performance liquid chromatography. The measurement data were analyzed by using statistic software SPSS 20.0. The results were expressed by xˉ± s and t test was conducted, with a statistical significance of P<0.05. Results The average concentration of rifampicin in pleural effusion was (2.2 ± 1.1) μg/ml by oral rifampicin alone. The concentration of rifampicin was (2.7±1.1)μg/ml, (3.0±1.4)μg/ml, (3.2±1.2)μg/ml, (2.8±1.2)μg/ml and (1.3± 1.1)μg/ml, respectively, at 0.5 h, 1, 2, 4, 8 h after combining local EP treatment. The results indicated that combining local EP treatment significantly increased the drug concentration in pleural effusion, which lasted for about 5 hours. Conclusions By applying rifampicin into pleural cavity through EP treatment with penetration of the chest wall, the concentration of rifampicin in pleural effusion of patients with tuberculous&nbsp;pleurisy could be increased. Combined with oral administration of rifampicin, this treatment could prolong the effective drug concentration in pleural effusion, which was beneficial to the bactericidal effects of rifampicin.