Moffett Brady S, Mattamal Raphael, Ocampo Elena C, Petit Christopher J
Department of Pharmacy, Texas Children's Hospital, Houston, TX 77030, USA.
Congenit Heart Dis. 2011 Jul-Aug;6(4):286-93. doi: 10.1111/j.1747-0803.2011.00536.x. Epub 2011 Jun 22.
To characterize the pharmacotherapeutic regimens used in infants with single ventricle heart disease and determine the influence of outpatient medications on interstage weight gain.
Retrospective review.
Tertiary care pediatric hospital.
All patients discharged from our institution with single ventricle heart disease that underwent neonatal first stage surgical palliation between 2002 and 2009 were included. Patients who died prior to second stage palliation or underwent orthotopic heart transplantation were excluded.
Outpatient medication regimens during the interstage period were reviewed. Medication regimens were compared between surgical eras and between patient groups experiencing different outcomes. A logistic regression model was developed to determine independent factors for an interstage increase in weight-for-age z-score (WAZ) and a linear regression model to determine medications significant for an increase in weight gain per day.
The study cohort consisted of 161 patients (58% male). Most patients in this cohort had either hypoplastic left heart syndrome (51%) or unbalanced complete atrioventricular canal (29%). Patients were placed on a median of four medications (range 1-9) at discharge from first surgical palliation, with aspirin (79%), furosemide (79%), and angiotensin converting enzyme inhibitors (ACE-I) (73%) most commonly prescribed. A median of six medication doses per day (range 2-18) were prescribed at discharge. Most patients (71%) had a decrease in WAZ during the interstage period. Use of digoxin (P < 0.01) and high-dose furosemide (P = .02) were associated with a decrease in WAZ score during the interstage period. Additionally, the use of ACE-I, ranitidine, proton-pump inhibitors, or promotility agents was not associated with improved somatic growth during the interstage period.
Infants with single ventricle heart disease have a high-medication burden during the interstage period. Despite the focused and intensified use of medications to improve feeding tolerance and somatic growth, current pharmacotherapeutic regimens appear to have little effect on interstage weight gain.
描述单心室心脏病婴儿所使用的药物治疗方案，并确定门诊药物对两期手术间隔期体重增加的影响。
回顾性研究。
三级儿科护理医院。
纳入2002年至2009年间在我院因单心室心脏病出院且接受新生儿一期手术姑息治疗的所有患者。排除在二期姑息治疗前死亡或接受原位心脏移植的患者。
回顾两期手术间隔期的门诊用药方案。比较不同手术时期以及不同预后患者组之间的用药方案。建立逻辑回归模型以确定年龄别体重Z评分（WAZ）在两期手术间隔期增加的独立因素，并建立线性回归模型以确定对每日体重增加有显著影响的药物。
研究队列包括161例患者（58%为男性）。该队列中的大多数患者患有左心发育不全综合征（51%）或不平衡型完全性房室通道（29%）。首次手术姑息治疗出院时，患者平均服用四种药物（范围为1 - 9种），最常开具的药物为阿司匹林（79%）、呋塞米（79%）和血管紧张素转换酶抑制剂（ACE - I）（73%）。出院时平均每天开具六种药物剂量（范围为2 - 18种）。大多数患者（71%）在两期手术间隔期WAZ下降。地高辛的使用（P < 0.01）和高剂量呋塞米的使用（P = 0.02）与两期手术间隔期WAZ评分下降相关。此外，ACE - I、雷尼替丁、质子泵抑制剂或促动力剂的使用与两期手术间隔期躯体生长改善无关。
单心室心脏病婴儿在两期手术间隔期的用药负担较重。尽管集中且强化使用药物以改善喂养耐受性和躯体生长，但目前的药物治疗方案似乎对两期手术间隔期体重增加影响甚微。
