在受体外膜氧化支持的儿科患者中,人体血衍生抗血的药理动力学
Dawoon Jung1, David Procaccini2, Jennifer Roem3
1Center for Translational Medicine, University of Maryland School of Pharmacy, Baltimore, MD, USA.
Journal of clinical pharmacology
|July 2, 2024
概括
抗血素 (AT) 替代对于由于肝素耐药性导致体外膜氧化 (ECMO) 的儿科患者至关重要. 这项研究特征AT的药理动力学,告知剂量维持治疗水平.
科学领域:
- 儿科重症监护医学 儿科重症监护医学
- 药理动力学 药理动力学
- 血液学 血液学 血液学
背景情况:
- 在重症儿童体外膜氧化 (ECMO) 具有高血栓栓塞事件的风险.
- 未分离的氨酸是标准的抗凝药,但获得的抗血素 (AT) 缺乏症可能会导致氨酸耐药性.
- 对AT活性监测和非标签的AT替代是常见的,但缺乏最佳剂量指南.
研究的目的:
- 在ECMO治疗的儿科患者中描述人体血衍生AT的药理动力学 (PK).
- 为接受ECMO的不同儿科年龄组开发基于证据的AT替代疗法.
- 在这个人群中建立最佳的治疗药物监测策略.
主要方法:
- 在单个学术中心对儿科ECMO患者 (0至<18岁) 的回顾性队列研究.
- 使用两部分的营业额模型来描述AT的药理动力学.
- 分析了PK参数,包括清除率,分布量和基底AT输入.
主要成果:
- 一个双隔间模型准确地描述了儿科ECMO患者的AT PK.
- 在ECMO的支持下,生物可利用的AT减少了50%,清除和分销量翻了一番.
- 在非ECMO条件下建立了PK参数估计.
结论:
- 建议针对新生儿和年龄较大的儿童使用ECMO的特定年龄的AT替代疗法,以保持目标AT活性水平.
- 强调治疗药物监测对于优化AT替代疗法的重要性.
- 提供了改善儿科ECMO抗凝管理的基础.
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