Notterman D A, Greenwald B M, Moran F, DiMaio-Hunter A, Metakis L, Reidenberg M M
Department of Pediatrics, New York Hospital-Cornell Medical Center 10021.
Clin Pharmacol Ther. 1990 Aug;48(2):138-47. doi: 10.1038/clpt.1990.128.
To learn if there are age-related differences in the pharmacokinetic behavior of dopamine, plasma dopamine clearance was determined in 27 acutely ill infants and children who were receiving a continuous intravenous infusion of the drug. Steady-state clearance was calculated from dopamine concentration in arterial blood. Dopamine clearance was 60.7 +/- 28.1 ml/kg/min. The age of the patient exerted an effect on clearance of dopamine (r = -0.63; p less than 0.05), and dopamine clearance was nearly twice as rapid in children younger than 2 years as it was in older children (82.3 +/- 27.7 ml/kg/min versus 45.9 +/- 17.0 mg/kg/min). Conjugated bilirubin exerted an age-independent effect on clearance of dopamine; clearance was 44.8 +/- 28.6 ml/kg/min in children with abnormal conjugated bilirubin (greater than or equal to 0.9 mg/dl) and 70.1 +/- 2.56 ml/kg/min in children with normal conjugated bilirubin (less than 0.9 mg/dl). Clearance was lowest (29.8 +/- 5.7 ml/kg/min) in the four children who had both hepatic and renal dysfunction. Age is an important determinant of dopamine clearance, explaining in part the clinical observation that infants and young children require higher infusion rates.
为了解多巴胺药代动力学行为是否存在年龄相关差异，我们测定了27例接受多巴胺持续静脉输注的急病婴幼儿的血浆多巴胺清除率。根据动脉血中的多巴胺浓度计算稳态清除率。多巴胺清除率为60.7±28.1毫升/千克/分钟。患者年龄对多巴胺清除率有影响（r = -0.63；p＜0.05），2岁以下儿童的多巴胺清除率几乎是大龄儿童的两倍（82.3±27.7毫升/千克/分钟对45.9±17.0毫克/千克/分钟）。结合胆红素对多巴胺清除率有与年龄无关的影响；结合胆红素异常（≥0.9毫克/分升）的儿童清除率为44.8±28.6毫升/千克/分钟，结合胆红素正常（＜0.9毫克/分升）的儿童清除率为70.1±2.56毫升/千克/分钟。在4例同时患有肝肾功能不全的儿童中，清除率最低（29.8±5.7毫升/千克/分钟）。年龄是多巴胺清除率的重要决定因素，这部分解释了婴幼儿需要更高输注速率的临床观察结果。
