PRELIMINARY STUDIES OF THE EFFECTS OF EXTRACORPOREAL MEMBRANE-OXYGENATOR ON THE DISPOSITION OF COMMON PEDIATRIC DRUGS
PRELIMINARY STUDIES OF THE EFFECTS OF EXTRACORPOREAL MEMBRANE-OXYGENATOR ON THE DISPOSITION OF COMMON PEDIATRIC DRUGS
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DOI：
10.1097/00007691-199308000-00001
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发表时间：
1993-08-01
影响因子：
2.5
通讯作者：
KOREN, G
中科院分区：
文献类型：
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作者：
DAGAN, O;KLEIN, J;KOREN, G
过去 15 年来，对于危重新生儿，体外膜肺氧合 (ECMO) 的使用有所增加。危重婴儿在接受ECMO治疗时，需要各种药物。我们进行了一项体外研究来评估膜氧合器对药物提取的潜在影响。以 320 毫升/分钟的速率设置两个闭合 ECMO 回路。一个电路是新的，另一个已临床使用了 5 天。每隔 1 小时将吗啡 8 ng/ml、庆大霉素 10 μg/ml、万古霉素 40 μg/ml、苯巴比妥 20 μg/ml 和苯妥英 20 μg/ml 注入回路中。注射后 10、30、60 和 240 分钟从回路中抽取血样。在新电路中，淘汰的药物如下：万古霉素36%、庆大霉素10%、苯巴比妥17%、苯妥英43%、吗啡36%。在使用的系统中，浓度下降幅度要小得多：万古霉素 11%、苯巴比妥 6%、庆大霉素 0%、苯妥英 0% 和吗啡 16%。在接受 20 微克/公斤/小时输注吗啡的儿童中，更换膜后，稳态浓度从 68.2 纳克/毫升降至 11.6 纳克/毫升。我们的数据表明，ECMO 与降低常用药物的浓度有关，并且该过程可能部分取决于膜的新旧程度。在这些变化可能导致针对接受 ECMO 的幼儿制定新的剂量指南之前，需要对新的和使用过的系统以及不同类型的 ECMO 进行更多实验。
There is an increased use of extracorporeal membrane oxygenation (ECMO) in the last 15 years for critically ill neonates. While receiving ECMO therapy, the critically ill infant needs various medications. We performed an in vitro study to evaluate the potential effect of the membrane oxygenator on drug extraction. Two closed ECMO circuits were set up at rates of 320 ml/min. One circuit was new and the other was used clinically for 5 days. Morphine at 8 ng/ml, gentamicin 10 mug/ml, vancomycin 40 mug/ml, phenobarbital 20 mug/ml, and phenytoin 20 mug/ml were injected into the circuit at 1-h intervals. Blood samples were drawn from the circuit at 10, 30, 60, and 240 minutes after injection. In the new circuit, drugs were eliminated as follows: vancomycin 36%, gentamicin 10%, phenobarbital 17%, phenytoin 43%, morphine 36%. In the used system, levels fell to a much smaller extent: vancomycin 11%, phenobarbital 6%, gentamicin 0%, phenytoin 0%, and morphine 16%. In a child receiving 20 mug/kg/h infusion of morphine, steady-state concentrations of 68.2 ng/ml fell to 11.6 ng/ml after changing the membrane. Our data indicate that the ECMO is associated with lowering of the concentrations of commonly used medications and that this process may depend partially on how new the membrane is. Before these changes may lead to new dosing guidelines for small children receiving ECMO, more experiments with new and used systems are warranted, as well as with different types of ECMO.