Clinical pharmacology of furosemide in children: a supplement.
Clinical pharmacology of furosemide in children: a supplement.
复制标题
DOI：
10.1097/00045391-200107000-00010
复制
发表时间：
2001-07-01
影响因子：
4.2
通讯作者：
Prandota, J
中科院分区：
文献类型：
--
作者：
Prandota, J
速尿是儿科实践中使用的最有效、毒性最小的利尿剂之一。实验和临床资料提示，肾上腺皮质激素和/或内源性瓦阿因样物质可能在其利尿作用中起重要作用。此外，这种药物似乎具有抗炎特性。不同疾病患儿口服或静脉给予1 ~ 2mg /kg剂量的呋塞米，尿药排泄率与尿流率呈显著正线性关系，但药物的对数剂量反应曲线因疾病和给药途径而异。没有获得s型对数剂量-反应曲线（即，在极低尿速排泄率时接近零反应，在极高排泄率时达到最大反应），这可能表明在这些患者中，肾小管对上述剂量的尿速排泄没有超过利尿反应的能力。然而，在患有不同疾病且肾功能正常的婴儿中，当静脉给药1 mg/kg时，发现一个非常陡峭的对数剂量-反应曲线，这可能表明更高的剂量可能不会导致利尿反应的显著增加。尿速尿的最低平均排泄率和尿中与显著利尿相关的尿浓度分别为0.58 +/- 0.33微克/千克/分钟和24.2 +/- 10.5微克/毫升。此外，在给药后的前6小时内尿中排泄的速尿量（以毫克计）与此期间收集的尿量之间存在显著相关性。囊性纤维化患者在平均口服剂量为0.835 +/- 0.18 mg/kg时，利尿反应明显比给予2 mg/kg的对照儿童更明显。在急性胃肠结肠炎或肾小球肾炎引起急性肾功能衰竭的儿童中，单次静脉注射呋塞米（1.2 ~ 30.8 mg/kg）与利尿反应之间存在广泛的关系。建议这些患者的每日总剂量不应超过100毫克。发现速尿对支气管收缩伴慢性肺病和上呼吸道狭窄的治疗有效；在婴儿期脑积水时避免脑脊液分流；在一些诊断程序中，如评估胎儿和新生儿肾积水；并在评价不同类型肾小管酸中毒。伴随该药临床使用的副作用包括：在服用利尿剂的同时接受全肠外营养的早产儿出现胆石症；接受长期速尿治疗的婴儿继发性甲状旁腺功能亢进和骨病还有药物引起的发烧。
Furosemide is one of the most effective and least toxic diuretics used in pediatric practice. Experimental and clinical data suggest that adrenocorticosteroids and/or endogenous ouabain-like substances may play an important role in its diuretic effect. Also, the drug appears to have anti-inflammatory properties. In children with different diseases who received orally or intravenously 1 to 2 mg/kg doses of furosemide, a statistically significant positive linear relationship was found between the drug urinary excretion rate and the urine flow rate, but log dose-response curves to the drug were found to vary depending on the disease and the route of the drug administration. No sigmoid-shaped log dose-response curve (ie, one approaching a zero response at very low furosemide urinary excretion rates and a maximum response at very high excretion rates) was attained, which may suggest that the capacity of the kidney tubules to respond diuretically to the aforementioned doses of furosemide was not exceeded in these patients. However, in infants with different diseases and reasonably normal renal function who required administration of this diuretic, a very steep log dose-response curve to a 1 mg/kg intravenous dose of furosemide was found, which may suggest that higher doses may not result in a significant increase in diuretic response. The lowest mean furosemide urinary excretion rate and its concentration in urine associated with a significant diuresis were found to be 0.58 +/- 0.33 microg/kg/min and 24.2 +/- 10.5 microg/ml, respectively. Also, a significant correlation was found between the amount (in milligrams) of furosemide excreted in the urine during the first 6 hours after administration and the urine volume collected during that time. Patients with cystic fibrosis appeared to have a markedly more pronounced diuretic response to the average oral dose of 0.835 +/- 0.18 mg/kg than that reported in control children given 2 mg/kg. In children with acute renal failure caused by acute gastroenterocolitis or glomerulonephritis, a broad relationship was observed between a single intravenous dose and diuretic response after administration of furosemide (1.2 to 30.8 mg/kg). It was suggested that the total daily dose of the drug should not exceed 100 mg in these patients. Furosemide was found to be effective in management of bronchoconstriction accompanying chronic lung disease and narrowing of the upper respiratory airways; in hydrocephalus in infancy to avoid cerebrospinal fluid shunts; in some diagnostic procedures, such as an assessment of fetal and neonatal hydronephrosis; and in evaluation of different types of renal tubular acidosis. Among side effects accompanying clinical use of this drug were cholelithiasis in premature infants receiving total parenteral nutrition concomitantly with the diuretic; secondary hyperparathyroidism and bone disease in infants obtaining long-term furosemide treatment; and drug-induced fever.