Hasan Rashed A, Benko Amy S, Nolan Brian M, Campe Julie, Duff Jenny, Zureikat George Y
Michigan State University, Hurley Medical Center, Flint, MI, USA.
Ann Pharmacother. 2003 Nov;37(11):1587-92. doi: 10.1345/aph.1C521.
Data on the cardiorespiratory changes and complications following administration of naloxone in children are limited.
To evaluate the cardiorespiratory changes and complications following naloxone treatment in children.
The maximal changes in respiratory rate (RR), heart rate (HR), systolic (SBP) and diastolic (DBP) blood pressure, and any complications within 1 and 2 hours following naloxone were tabulated.
One hundred ninety-five children received naloxone over 3 years. The mean +/- SD age was 9.7 +/- 6 years. The total doses of naloxone ranged from 0.01 to 7 mg (0.001-0.5 mg/kg body weight), with a median dose of 0.1 mg. Group 1 patients consisted of 116 (60%) children who were postoperative and had been given naloxone by an anesthesiologist; group 2 patients consisted of 79 (40%) children who received naloxone in the emergency department or pediatric intensive care unit. Patients in group 1 were older: 10.6 +/- 5.3 versus 8.2 +/- 6.7 years (p < 0.006), but received significantly lower doses of naloxone (0.09 +/- 0.2 vs. 1.1 +/- 0.76 mg; p < 0.001). When the entire cohort was evaluated, a significant increase in RR (15 +/- 7 vs. 21 +/- 8 breaths/min; p < 0.001), HR (102 +/- 29 vs.107 +/- 29 beats/min; p < 0.001), SBP (109 +/- 17 vs. 115 +/- 15 mm Hg; p < 0.001), and DBP (56 +/- 10 vs. 60 +/- 13 mm Hg; p < 0.001) within 1 hour following naloxone was noted. When the 2 groups were compared, only the changes in RR were greater in group 2 patients (6.8 +/- 7.9 vs. 4.7 +/- 5 breaths/min; p < 0.001) following naloxone. Systolic hypertension occurred in 33 of 195 (16.9%) of all patients, while diastolic hypertension occurred in 13 (6.6%) of all patients after naloxone. Only the incidence of diastolic hypertension was higher in group 2 compared with group 1 patients following naloxone (16% vs. 2%; p < 0.001). Hypertension resolved spontaneously. One child developed pulmonary edema and required positive pressure ventilation for 22 hours.
Moderate increases in RR, HR, and BP occur after naloxone administration to children, but development of more serious complications is rare.
关于儿童使用纳洛酮后的心肺变化及并发症的数据有限。
评估儿童使用纳洛酮治疗后的心肺变化及并发症。
将纳洛酮给药后1小时和2小时内呼吸频率（RR）、心率（HR）、收缩压（SBP）和舒张压（DBP）的最大变化以及任何并发症制成表格。
在3年期间，195名儿童接受了纳洛酮治疗。平均年龄±标准差为9.7±6岁。纳洛酮的总剂量范围为0.01至7毫克（0.001 - 0.5毫克/千克体重），中位剂量为0.1毫克。第1组患者包括116名（60%）术后由麻醉医生给予纳洛酮的儿童；第2组患者包括79名（40%）在急诊科或儿科重症监护病房接受纳洛酮治疗的儿童。第1组患者年龄较大：10.6±5.3岁对8.2±6.7岁（p<0.006），但接受的纳洛酮剂量显著较低（0.09±0.2对1.1±0.76毫克；p<0.001）。对整个队列进行评估时，纳洛酮给药后1小时内RR（15±7对21±8次/分钟；p<0.001）、HR（102±29对107±29次/分钟；p<0.001）、SBP（109±17对115±15毫米汞柱；p<0.001）和DBP（56±10对60±13毫米汞柱；p<0.001）均有显著增加。比较两组时，纳洛酮给药后第2组患者仅RR变化更大（6.8±7.9对4.7±5次/分钟；p<0.001）。195名患者中有33名（16.9%）出现收缩期高血压，纳洛酮给药后13名（6.6%）出现舒张期高血压。纳洛酮给药后，仅第2组舒张期高血压的发生率高于第1组患者（16%对2%；p<0.001）。高血压可自发缓解。1名儿童发生肺水肿，需要进行22小时的正压通气。
儿童使用纳洛酮后RR、HR和BP会适度升高，但发生更严重并发症的情况罕见。
