小于胎龄儿早产儿呼吸暂停时茶碱的动力学

Kinetics of theophylline in apnea of prematurity in small for gestational age babies.

作者信息

Chaudhuri M, Garg S K, Narang A, Bhakoo O N

机构信息

Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh.

出版信息

Indian Pediatr. 1996 Mar;33(3):181-7.

PMID:8772836

Abstract

OBJECTIVES

To study the pharmacokinetics of theophylline and its correlations to pharmacodynamic effects in apnea of prematurity in small for gestational age babies.

DESIGN

Prospective case control study.

SETTING

Level III Neonatal Intensive Care Unit.

SUBJECTS

Ten small for gestational age (SGA) babies and 10 gestation matched appropriate for gestational age (AGA) babies with recurrent apnea of prematurity.

METHODS

All babies were investigated to exclude secondary causes of apnea. 5 mg/kg of aminophylline loading dose followed by 2 mg/kg as maintenance dose every 8 hourly intravenously was used. The trough and peak levels of theophylline were assessed on different days of therapy. Clinical monitoring was done for the efficacy and toxicity of the drug. Analysis was done using unpaired Student's 't' test and the correlation between plasma theophylline levels of different days was performed by using ANOVA.

RESULTS

The therapeutic drug levels were achieved within 24 hours in all babies. The SGA babies showed 25% higher drug levels as compared to AGA babies. The mean trough plasma theophylline levels ranged from 8.15 +/- 1.59 to 12.37 +/- 1.54 micrograms/ml in SGA babies while in AGA babies they ranged from 6.26 +/- 1.93 to 9.96 +/- 1.96 micrograms/ml in first 8 days of therapy. The mean peak levels in SGA babies ranged from 11.91 +/- 1.84 to 17.13 +/- 1.63 micrograms/ml and in AGA babies ranged from 8.17 +/- 1.84 to 13.02 +/- 1.48 micrograms/ml. Twenty per cent SGA and AGA babies each developed clinical toxicity though toxic drug levels were found in 50% SGA and 30% AGA babies.

CONCLUSION

There is a need to modify dosage schedule for these babies.

摘要

目的

研究小孕周早产儿呼吸暂停时氨茶碱的药代动力学及其与药效学效应的相关性。

设计

前瞻性病例对照研究。

地点

三级新生儿重症监护病房。

研究对象

10例小孕周（SGA）早产儿和10例孕周匹配的适于胎龄（AGA）早产儿，均有反复呼吸暂停。

方法

对所有婴儿进行检查以排除呼吸暂停的继发原因。静脉注射氨茶碱负荷剂量5mg/kg，随后每8小时静脉注射维持剂量2mg/kg。在治疗的不同日期评估氨茶碱的谷值和峰值水平。对药物的疗效和毒性进行临床监测。采用非配对学生t检验进行分析，使用方差分析（ANOVA）对不同日期的血浆氨茶碱水平之间的相关性进行分析。

结果

所有婴儿在24小时内达到治疗药物水平。与AGA婴儿相比，SGA婴儿的药物水平高25%。在治疗的前8天，SGA婴儿的平均血浆氨茶碱谷值水平为8.15±1.59至12.37±1.54微克/毫升，而AGA婴儿为6.26±1.93至9.96±1.96微克/毫升。SGA婴儿的平均峰值水平为11.91±1.84至17.13±1.63微克/毫升，AGA婴儿为8.17±1.84至13.02±1.48微克/毫升。20%的SGA婴儿和AGA婴儿出现临床毒性，尽管在50%的SGA婴儿和30%的AGA婴儿中发现了中毒药物水平。