- 期刊
Renal Effects and Urinary Excretion of Prostaglandin Following Indomethacin Therapy in Premature Infants with Patent Ductus Arteriosus
使用Indomethacin治療早産兒開放性動脈導管時的腎機能變化與尿液中前列腺素的關係
摘要
在十位臨床上具有顯著意義之開放性動脈導管的早産兒，（出生體重：1245±290公克，懷孕週數：32±2.2週，出生日數：7.7±3.8天），使用一刻靜動脈給予的indomethacin(0.3mg/kg)以後。我們對其腎臟功能障礙與尿液中前列腺素(prostaglandin)分泌的狀況加以評估。結果在使用indomethacin後，其尿液輸出量(urinary output)，溶質之廓清率(osmolal clearance)與純水之廓清率(free water dearance)治療前作比較，發現其在統計學上有明顯的下降。而鈉與氯離子的部分流失率(fractional excretion)，腎絲球廓清率，及尿液中所排出的前列腺素E2雖有降低，但與治療前作比較則在統計學上無明顯的差異。 若將病人依indomethacin治療的療效，即動脈導管關閉與否分爲兩組，則可發現關閉組較未關閉組，雖其血清中indomethacin的濃度較高，但其腎功能障礙則較不明顯。此一現象可能表示：動脈導管關閉所産生的腎臟血流動力學(renal hemodynamics)的變化，可減輕indomethacin所産生的腎臟功能障礙。
並列摘要
Renal side effects and urinary prostaglandin were evaluated in 10 premature infants (Mean±SD:BW 1245±290gm, GA 32+2.2 wks, Postnatal age 77±3.8 days) with signLji cant PDA who were given one dose of indomethacin (0.3 mg/kg intravenously). There was a significant decrease in urinary output, osmolal and free water clearance after therapy. The fractional excretion of sodium, chloride, potassiun, glomerular filtration rate and urinary prostaglandin E2 also decreased but were not statistically different from the baseline values. In infants who responded to indomethacin with ductus closure, their renal functions appeared to be preserved even though they had higher plasma indomethacin levels than the non-responders in whom significant changes in renal function were observed following indomethacin therapy. This observation suggested that the improved renal hemodynamics following the closure of the ductus may minimize or attenuate the renal side effects of indomethacin.