Carrion E, Hertzog J H, Medlock M D, Hauser G J, Dalton H J
Department of Pediatrics, Division of Pediatric Critical Care and Pulmonary Medicine, Georgetown University Medical Center, Washington, DC, USA.
Arch Dis Child. 2001 Jan;84(1):68-71. doi: 10.1136/adc.84.1.68.
Acetazolamide (ACTZ), a carbonic anhydrase inhibitor, has been shown to decrease cerebrospinal fluid (CSF) production in both in vivo and in vitro animal models. We report two children with hydrocephalus who experienced multiple shunt failures, and who had externalised ventriculostomy drains (EVD) prior to ventriculopleural shunt placement. The effects of increasing doses of ACTZ on CSF production and subsequent tolerance to ventriculopleural shunts were evaluated. The patients had a 48% and a 39% decrease in their EVD CSF output when compared to baseline with maximum ACTZ dose of 75 mg/kg/day and 50 mg/kg/day, respectively (p < 0.05). This is the first report of change in CSF volume in children after extended treatment with ACTZ. ACTZ treatment in mechanically ventilated paediatric patients with hydrocephalus may improve tolerance of ventriculopleural shunts and minimise respiratory compromise. Potassium and bicarbonate supplements are required to correct metabolic disturbances.
乙酰唑胺（ACTZ）是一种碳酸酐酶抑制剂，在体内和体外动物模型中均已显示可减少脑脊液（CSF）生成。我们报告了两名患有脑积水且经历多次分流失败的儿童，他们在进行脑室胸膜分流术之前已放置了外置脑室引流管（EVD）。评估了递增剂量的ACTZ对脑脊液生成以及随后对脑室胸膜分流术耐受性的影响。与基线相比，最大ACTZ剂量分别为75 mg/kg/天和50 mg/kg/天时，两名患者的EVD脑脊液输出量分别减少了48%和39%（p<0.05）。这是关于ACTZ长期治疗后儿童脑脊液量变化的首次报告。对机械通气的小儿脑积水患者进行ACTZ治疗可能会提高对脑室胸膜分流术的耐受性，并最大程度减少呼吸功能损害。需要补充钾和碳酸氢盐以纠正代谢紊乱。
