Department of Oncology, St. Jude Children's Research Hospital , Memphis, Tennessee.
J Palliat Med. 2013 Nov;16(11):1486-8. doi: 10.1089/jpm.2012.0600. Epub 2013 Jun 7.
Opioid-induced constipation is commonly seen in pediatrics, especially at the end of life. As patients clinically decline, constipation often leads to increased pain and distress, while its enteral treatment becomes more challenging.
There is little information about the safety and use of methylnaltrexone in children. We present the case of a 17-month-old girl with progressive leukemia who was at the end of her life and whose severe opioid-induced constipation and rectal prolapse was successfully treated with the μ-opioid-receptor antagonist methylnaltrexone. We selected a lower dose based on our lack of experience with methylnaltrexone in this age group and concern for potential complications given her rectal prolapse.
Opioid-induced constipation, abdominal distention, and rectal prolapse caused our patient's most distressing symptoms, even in the context of advanced cancer. A single dose of subcutaneous methylnaltrexone (0.12 mg/kg) resolved her constipation and rectal prolapse within one hour. Although evidence is limited, the drug has successfully been used in pediatric patients with no reported side effects to date. We recommend its use earlier in the course of severe opioid-induced constipation in children unable to tolerate an oral laxation regimen. Prospective research is needed to establish the parameters for use of this effective agent in children who cannot tolerate other regimens.
阿片类药物引起的便秘在儿科中很常见，尤其是在生命末期。随着患者病情的恶化，便秘常常导致疼痛和不适加剧，而其肠内治疗变得更加具有挑战性。
关于儿童使用美沙酮的安全性和使用信息很少。我们报告了一例 17 个月大的进展性白血病女孩的病例，她生命垂危，严重的阿片类药物引起的便秘和直肠脱垂通过 μ-阿片受体拮抗剂美沙酮成功治疗。我们根据在该年龄段使用美沙酮的经验不足，并考虑到她直肠脱垂的潜在并发症，选择了较低的剂量。
阿片类药物引起的便秘、腹胀和直肠脱垂导致我们的患者出现最痛苦的症状，即使在晚期癌症的情况下也是如此。单次皮下给予美沙酮（0.12mg/kg）可在一小时内缓解便秘和直肠脱垂。尽管证据有限，但该药物已成功用于儿科患者，迄今为止没有报告任何副作用。我们建议在不能耐受口服泻药方案的严重阿片类药物引起的便秘患儿中更早使用该药。需要前瞻性研究来确定该有效药物在不能耐受其他方案的儿童中的使用参数。
