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基于口服克隆丁的策略,在新生儿脑病的冷却期间减少阿片类药物的使用:一项观察性研究
Haley Fribance1, Caroline Liang1, Carlton K K Lee2
1Department of Pharmacy, Johns Hopkins Bayview Medical Center, Baltimore, MD.
The Journal of pediatrics
|June 18, 2024
概括
在治疗性低温 (TH) 期间,基于克洛尼丁的镇静策略 (CLON) 降低了与吗啡 (MOR) 相比的阿片类药物使用. 该CLON协议证明了与MOR相似的安全性和有效性,减少了救援阿片类药物和异型药物的需求.
科学领域:
- 新生儿神经病学 新生儿神经病学
- 儿科重症监护 儿科重症监护
- 药理学 药理学是指药理学的学科.
背景情况:
- 治疗性低温 (TH) 是新生儿缺氧性缺血性脑病变 (HIE) 的标准治疗方法.
- 镇静在TH期间至关重要,基于吗啡 (MOR) 的策略是常见的.
- 需要使用替代镇静方案来优化阿片类药物使用和血液动力学稳定性.
研究的目的:
- 在接受HIETH的新生儿中,将基于克罗尼丁的静止策略 (CLON) 与基于吗啡的策略 (MOR) 进行比较.
- 评估CLON对阿片类药物需求,安全性和有效性的影响.
- 评估血液动力学变化和需要额外的血管活性支持.
主要方法:
- 2017年1月至2021年10月,在IV级NICU进行单中心观察性研究.
- 根据协议过渡,患者被分为MOR (2020年4月之前) 和CLON (2020年8月之后) 组.
- 主要结局:总和救援吗啡毫克相当量/公斤;次要结局:血液动力学变化.
主要成果:
- 与MOR组 (74名新生儿) 相比,CLON组 (25名新生儿) 显示了显著较低的吗啡毫克相当量/公斤和救援阿片类药物需求.
- 随着TH日的推进,CLON组中需要救援阿片类药物的患者越来越少.
- 莫尔组的低血压更频繁,需要更高的多巴胺剂量和额外的内类药物/皮.
结论:
- 基于肠道克罗尼丁的镇静方案与基于吗啡的策略相比,对于接受TH的HIE新生儿来说,它不逊色.
- 克隆似乎可以降低阿片类和异能类药物需求,同时保持感知有效性和血液动力学安全性.
- 这表明CLON可以作为一种可行的替代方案,用于在HIE中TH期间的镇静.
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