Saarenmaa E, Neuvonen P J, Fellman V
Hospital for Children and Adolescents and the Department of Clinical Pharmacology, University of Helsinki, Finland.
J Pediatr. 2000 Jun;136(6):767-70.
To provide a rational basis for the dosage of fentanyl in newborn infants by determining clearance in the first days of life.
A continuous infusion of fentanyl for 2 to 3 days (10. 5 microg/kg over a 1-hour period followed by 1.5 microg/kg/h) was administered to 38 newborn infants who had undergone ventilation (gestational ages 26 to 42 weeks and birth weights 835 to 3550 g). Fentanyl concentrations were measured in arterial blood samples collected at 2, 12, 24, 48, and 60 hours after the start of fentanyl infusion. Fentanyl levels were correlated with a pain score.
The mean (+/-SD) steady-state fentanyl concentration of 2.5 (+/-1) ng/mL achieved between 24 and 48 hours of infusion correlated significantly with the concomitant pain score (r = -0.57, P <.01). The clearance, 11.5 (+/-4.0) mL/min/kg, correlated significantly with the gestational age (r = 0.46, P <.01) and birth weight (r = 0. 48, P <.01).
Because plasma fentanyl clearance increases with maturity, gestational age should be taken into account when fentanyl is administered to newborn infants.
通过测定新生儿出生后最初几天的清除率，为新生儿芬太尼的剂量提供合理依据。
对38例接受通气治疗的新生儿（胎龄26至42周，出生体重835至3550克）持续输注芬太尼2至3天（1小时内输注10.5微克/千克，随后以1.5微克/千克/小时的速度输注）。在芬太尼输注开始后2、12、24、48和60小时采集动脉血样本，测定芬太尼浓度。芬太尼水平与疼痛评分相关。
输注24至48小时期间达到的平均（±标准差）稳态芬太尼浓度为2.5（±1）纳克/毫升，与同时的疼痛评分显著相关（r = -0.57，P <.01）。清除率为11.5（±4.0）毫升/分钟/千克，与胎龄（r = 0.46，P <.01）和出生体重（r = 0.48，P <.01）显著相关。
由于血浆芬太尼清除率随成熟度增加，给新生儿使用芬太尼时应考虑胎龄。
