Loirat P, Rohan J, Baillet A, Beaufils F, David R, Chapman A
N Engl J Med. 1978 Oct 26;299(17):915-9. doi: 10.1056/NEJM197810262991703.
The clearance of endogenous creatinine in 20 burned patients, measured between the fourth and the 35th post-burn day, was a mean (+/- S.D.) of 172.1 p 48.4 ml per minute per 1.73 m2; in eight normal subjects the mean value was 125.4 g- 10.4 (P less than 0.02). Thirteen patients had values more than 2 S.D. above the normal mean. We confirmed this rise in glomerular filtration rate by measuring inulin or iothalamate clearance in nine patients. The pharmacokinetics of tobramycin were studied in 11 of the 20 patients and in eight normal subjects receiving continuous intravenous infusions of the drug. An inverse correlation was found between plasma half-life of the drug and creatinine clearance (r = 0.68, P less than 0.01). Increased creatinine clearances and shortened half-life of tobramycin occurred mainly in younger patients. Glomerular filtration rates in burned patients may rise to very high values and can be validly measured by creatinine clearance. The plasma half-lives of drugs with predominantly urinary excretion may decrease in patients with burns.
在20名烧伤患者中，于烧伤后第4天至第35天期间测定的内生肌酐清除率，平均（±标准差）为每分钟每1.73平方米172.1±48.4毫升；8名正常受试者的平均值为125.4±10.4（P<0.02）。13名患者的值高于正常平均值2个标准差以上。我们通过测定9名患者的菊粉或碘他拉酸盐清除率，证实了肾小球滤过率的这种升高。在20名患者中的11名以及8名接受该药物持续静脉输注的正常受试者中研究了妥布霉素的药代动力学。发现该药物的血浆半衰期与肌酐清除率之间呈负相关（r = 0.68，P<0.01）。肌酐清除率增加和妥布霉素半衰期缩短主要发生在年轻患者中。烧伤患者的肾小球滤过率可能升至非常高的值，并且可以通过肌酐清除率有效地进行测量。主要经尿液排泄的药物的血浆半衰期在烧伤患者中可能会缩短。
