新生儿使用利尿药物:法国处方药数据库分析
Silvia Iacobelli1,2, Simon Lorrain2, Ezira Rabe2
1Néonatologie, Réanimation Néonatale et Pédiatrique, CHU Saint Pierre, Saint Pierre, France.
Frontiers in pharmacology
|March 28, 2024
概括
在新生儿重症监护病房使用利尿剂是常见的,特别是早产婴儿,但往往缺乏证据,并且在各中心之间有很大的差异. 处方做法可能会超过安全的剂量和持续时间限制.
科学领域:
- 新生儿科学 新生儿科学
- 儿科药理学 儿科药理学
- 临床药房 临床药房
背景情况:
- 利尿剂的使用在新生儿重症监护室 (NICU) 普遍存在,尽管对许多适应症有效性的证据有限.
- 这项研究涉及法国一大多中心新生儿队列中广泛处方利尿剂的情况.
研究的目的:
- 确定法国NICU中尿剂暴露的总比率.
- 分析利尿剂使用的趋势,常见的指示,处方模式和中心间的变化.
- 评估新生儿注射利尿剂的安全性和证据基础.
主要方法:
- 在40个法国3级NICU进行了观察性研究.
- 数据来自于2017年1月至2021年12月期间住院的新生儿的计算机化订单入口系统.
- 符合条件的新生儿在入院时经过纠正的妊娠年龄在24至44周之间.
主要成果:
- 总共有86,032名新生儿被纳入,其整体利尿剂暴露率为8.5%.
- 在早产婴儿 (<32周怀孕,29.4%) 的暴露明显高于期满新生儿 (3.7%).
- 在中心之间观察到暴露率的显著变化 (2.4%至26.5%),随着时间的推移没有显著变化. 富罗塞米德,螺旋和多巴胺通常用于液体保留,支气管肺功能障碍以及输血后的指示.
结论:
- 利尿剂处方实践显示出相当大的中心间变异性,这表明人们不一致地遵守基于证据的指导方针.
- 新生儿注射利尿剂往往是基于无证据的,剂量和持续时间可能超过毒性值.
- 需要进一步的研究和标准化的指导方针来优化新生儿护理中的利尿剂使用.
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