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目的揭示抗生素锁(ALT)技术在防治中心静脉导管(CVC)感染过程中可否产生耐药性,对血管内皮细胞(VEC)有无损伤,旨在指导ALT技术的合理应用。方法制作内含细菌生物膜的导管,将其植入动物的血管内,将动物随机分三组:导管组,向导管内注入头孢他啶-肝素混合液;全身组,肌肉注射头孢他啶,导管内注入无菌生理盐水-肝素混合液;联合组,在肌肉注射头孢他啶的同时,向导管内注入头孢他啶-肝素混合液,连续观察10天,每天在更换药液前取外周血,测血管内皮细胞损伤标记物(vWF),第11天停用抗菌药物,带管5天观察vWF,然后拔出导管,拔管前取外周血,再测vWF,并用纸片扩散法做药敏实验。结果从置管第2天起至拔管,三组动物外周血vWF含量均升高,且全身组显著高于其他两组,(P<0.05),差异有统计学意义。结论 VEC损伤与CVC的置留和感染的程度有关,与ALT技术无关;与全身使用抗菌药物比较,ALT技术更不易产生耐药。
Objective To reveal whether antibiotic lock (ALT) can prevent drug-resistant vascular endothelial cells (VECs) during the prevention and treatment of central venous catheter (CVC) infection and aim to guide the rational use of ALT. Methods The catheter containing bacterial biofilm was made and implanted into the blood vessels of animals. The animals were randomly divided into three groups: catheter group, ceftazidime-heparin mixture injected into the catheter; systemic group, intramuscular injection of ceftazidime, Saline-heparin mixture; combined group, ceftazidime intramuscular injection at the same time, to the catheter ceftazidime - heparin mixture, continuous observation of 10 days, every day before taking the replacement of peripheral blood, measuring vascular endothelial cell damage marker (vWF ), Antibiotics were stopped on the 11th day, vWF was observed with a tube for 5 days, then the catheter was pulled out, the peripheral blood was taken before extubation, and the vWF was measured again. Results From the second day after catheterization to extubation, the content of vWF in the peripheral blood of the three groups of animals increased, and the whole body group was significantly higher than the other two groups (P <0.05). The difference was statistically significant. Conclusions The VEC damage is related to the degree of resident and infection of CVC and has nothing to do with the ALT technique. Compared with systemic antibiotics, ALT technique is less likely to develop resistance.