Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio 43205, USA.
Pediatr Blood Cancer. 2010 Apr;54(4):559-62. doi: 10.1002/pbc.22395.
Constipation is a frequent adverse drug event seen with opioids, the first-line therapy for sickle cell pain crises. Proactive use of laxatives and stool softeners is recommended when opioids are prescribed. Our objective was to generate national estimates of the inpatient use of laxatives during opioid administration in children with sickle cell disease (SCD) and identify associations between individual and hospital-level factors and laxative prescription.
We analyzed data from 29 children's hospitals in the Pediatric Health Information System, extracting patients 0-18 years of age with SCD hospitalized between 7/1/2007 and 6/30/2008. Our main outcome measure was the percentage of opioid-receiving patients who also received a laxative or stool softener.
Six thousand ninety-three total SCD admissions received opioids. Two-thirds (66%) of patients received at least one laxative, and 31% received more than one. The most commonly prescribed constipation medication was polyethylene glycol-electrolyte solution (42.0%), followed by docusate (31.4%) and senna (13.6%). Logistic regression revealed that increasing age was associated with increased use of laxatives, as were length of stay >1 day (OR = 3.12), medical as compared to surgical admissions (OR = 4.16), and discharge diagnosis of constipation (OR = 18.6). Patients were somewhat less likely to receive laxatives in small and large volume hospitals as compared to medium hospitals.
A substantial number of hospitalized patients with SCD receiving opioids do not receive laxatives and there is unexpected variability in the use of these medications. Increased attention needs to be paid to constipation prophylaxis in patients with SCD, particularly in younger patients and post-surgical patients.
便秘是阿片类药物常见的药物不良反应，而阿片类药物是治疗镰状细胞危象的一线药物。当开具阿片类药物时，建议积极使用泻药和大便软化剂。我们的目标是生成全国范围内在儿童镰状细胞病（SCD）患者中使用阿片类药物时使用泻药的估计值，并确定个体和医院水平因素与开泻药处方之间的关联。
我们分析了来自儿科健康信息系统的 29 家儿童医院的数据，提取了 2007 年 7 月 1 日至 2008 年 6 月 30 日期间住院的 0-18 岁 SCD 患者。我们的主要结果衡量标准是接受阿片类药物的患者中有多少人还接受了泻药或大便软化剂。
总共 6093 例 SCD 入院患者接受了阿片类药物。三分之二（66%）的患者至少接受了一种泻药，31%的患者接受了一种以上的泻药。最常开的便秘药物是聚乙二醇电解质溶液（42.0%），其次是多库酯（31.4%）和番泻叶（13.6%）。逻辑回归显示，年龄增长与使用泻药的增加有关，住院时间超过 1 天（OR=3.12）、内科与外科入院（OR=4.16）以及便秘诊断（OR=18.6）也是如此。与中型医院相比，小医院和大医院的患者接受泻药的可能性略低。
接受阿片类药物治疗的大量住院 SCD 患者没有接受泻药，而且这些药物的使用存在意外的差异。需要更加关注 SCD 患者的便秘预防，特别是在年轻患者和手术后患者中。
