甲纳曲酮治疗阿片类药物引起的重症婴幼儿运动障碍:一项试点研究。

Q2 Medicine Journal of Pediatric Pharmacology and Therapeutics Pub Date : 2023-01-01 Epub Date: 2023-04-26 DOI:10.5863/1551-6776-28.2.136
Christina J Smith, Caroline M Sierra, Joanna Robbins, Nancy Y Chang, Farrukh Mirza
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引用次数: 0

摘要

目的:重症儿科患者通常会出现阿片类药物引起的运动障碍。甲纳曲酮是一种皮下注射、外周作用的μ-阿片受体拮抗剂,对于阿片类药物引起的运动障碍患者来说,它是肠内泻药的理想辅助药物。在重症儿科患者中使用甲基纳曲酮的数据非常有限。本研究旨在确定甲基纳曲酮治疗阿片类药物引起的重症婴幼儿运动障碍的有效性和安全性:本回顾性分析纳入了 2013 年 1 月 1 日至 2020 年 9 月 15 日期间在一家学术机构的儿科重症监护病房接受皮下注射甲纳曲酮治疗的 18 岁以下患者。结果包括肠蠕动发生率、肠内营养喂养量和药物不良事件:24 名患者的中位年龄为 3.5 岁(IQR,0.58-11.1),共接受了 72 次甲基纳曲酮治疗。中位剂量为 0.15 毫克/千克(IQR,0.15-0.15)。在服用甲纳曲酮时,患者口服吗啡毫克当量(MMEs)的平均值(± SD)为 7.5 ± 4.5 毫克/千克/天,在服用甲纳曲酮前,患者服用阿片类药物的中位数为 13 天(IQR,8.8-21)。43 人(60%)在用药后 4 小时内排便,58 人(81%)在用药后 24 小时内排便。给药后,肠内营养容量增加了 81% (p = 0.002)。三名患者出现呕吐,两名患者接受了止呕药物治疗。镇静或疼痛评分未见明显变化。用药后,戒断评分和每日口服 MME 均有所下降(p = 0.008 和 p = 0.002):甲纳曲酮可有效治疗阿片类药物引起的儿科重症患者运动障碍,且不良反应风险较低。
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Methylnaltrexone for Opioid-Induced Dysmotility in Critically Ill Infants and Children: A Pilot Study.

Objective: Critically ill pediatric patients commonly experience opioid-induced dysmotility. Methylnaltrexone, a subcutaneously administered, peripherally acting mu-opioid receptor antagonist, is a compelling adjunct to enteral laxatives in patients with opioid-induced dysmotility. Data for methylnaltrexone use in critically ill pediatric patients are limited. The purpose of this study was to determine the effectiveness and safety of methylnaltrexone for opioid-induced dysmotility in critically ill infants and children.

Methods: Patients younger than 18 years who received subcutaneous methylnaltrexone from January 1, 2013, through September 15, 2020, in the pediatric intensive care units at an academic institution were included in this retrospective analysis. Outcomes included incidence of bowel movement, enteral nutrition feeding volume, and adverse drug events.

Results: Twenty-four patients, median age 3.5 years (IQR, 0.58-11.1), received 72 methylnaltrexone doses. The median dose was 0.15 mg/kg (IQR, 0.15-0.15). Patients were receiving a mean ± SD of 7.5 ± 4.5 mg/kg/day of oral morphine milligram equivalents (MMEs) at methylnaltrexone administration and received opioids for median 13 days (IQR, 8.8-21) prior to methylnaltrexone administration. A bowel movement occurred within 4 hours following 43 (60%) administrations and within 24 hours following 58 (81%) administrations. Enteral nutrition volume increased by 81% (p = 0.002) following administration. Three patients had emesis and 2 received anti-nausea medication. No significant changes in sedation or pain scores were observed. Withdrawal scores and daily oral MMEs decreased following administration (p = 0.008 and p = 0.002, respectively).

Conclusions: Methylnaltrexone may be an effective treatment for opioid-induced dysmotility in critically ill pediatric patients with low risk of adverse effects.

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来源期刊
Journal of Pediatric Pharmacology and Therapeutics
Journal of Pediatric Pharmacology and Therapeutics Medicine-Pediatrics, Perinatology and Child Health
CiteScore
2.40
自引率
0.00%
发文量
90
期刊介绍: The Journal of Pediatric Pharmacology and Therapeutics is the official journal of the Pediatric Pharmacy Advocacy Group. JPPT is a peer-reviewed multi disciplinary journal that is devoted to promoting the safe and effective use of medications in infants and children. To this end, the journal publishes practical information for all practitioners who provide care to pediatric patients. Each issue includes review articles, original clinical investigations, case reports, editorials, and other information relevant to pediatric medication therapy. The Journal focuses all work on issues related to the practice of pediatric pharmacology and therapeutics. The scope of content includes pharmacotherapy, extemporaneous compounding, dosing, methods of medication administration, medication error prevention, and legislative issues. The Journal will contain original research, review articles, short subjects, case reports, clinical investigations, editorials, and news from such organizations as the Pediatric Pharmacy Advocacy Group, the FDA, the American Academy of Pediatrics, the American Society of Health-System Pharmacists, and so on.
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