Division of Pediatric Palliative Care, Children's Hospital of Richmond at VCU, Virginia Commonwealth University Medical Center, 1250 East Marshall Street, Richmond, VA 23298, USA.
Heart Lung. 2013 Nov-Dec;42(6):407-13. doi: 10.1016/j.hrtlng.2013.07.008. Epub 2013 Sep 3.
The purpose of this study was to, in a pediatric population, describe the frequency of opioid withdrawal signs and symptoms and to identify factors associated with these opioid withdrawal signs and symptoms.
Opioids are used routinely in the pediatric intensive care population for analgesia, sedation, blunting of physiologic responses to stress, and safety. In children, physical dependence may occur in as little as 2-3 days of continuous opioid therapy. Once the child no longer needs the opioid, the medications are reduced over time.
A prospective, descriptive study was conducted. The sample of 26 was drawn from all patients, ages 2 weeks to 21 years admitted to the Children's Hospital of Richmond pediatric intensive care unit (PICU) and who have received continuous infusion or scheduled opioids for at least 5 days. Data collected included: opioid withdrawal score (WAT-1), opioid taper rate (total dose of opioid per day in morphine equivalents per kilogram [MEK]), pretaper peak MEK, pretaper cumulative MEK, number of days of opioid exposure prior to taper, and age.
Out of 26 enrolled participants, only 9 (45%) had opioid withdrawal on any given day. In addition, there was limited variability in WAT-1 scores. The most common symptoms notes were diarrhea, vomit, sweat, and fever.
For optimal opioid withdrawal assessments, clinicians should use a validated instrument such as the WAT-1 to measure for signs and symptoms of opioid withdrawal. Further research is indicated to examine risk factors for opioid withdrawal in children.
本研究旨在描述儿科人群中阿片类药物戒断症状和体征的发生频率，并确定与这些阿片类药物戒断症状和体征相关的因素。
阿片类药物在儿科重症监护病房中常规用于镇痛、镇静、减轻生理应激反应以及保障安全。在儿童中，连续接受阿片类药物治疗 2-3 天即可出现躯体依赖。一旦患儿不再需要阿片类药物，药物将逐渐减量。
进行了一项前瞻性描述性研究。该研究的样本来自所有年龄在 2 周至 21 岁之间、因接受持续输注或计划使用阿片类药物治疗至少 5 天而入住里士满儿童医院儿科重症监护病房（PICU）的患者。收集的数据包括：阿片类药物戒断评分（WAT-1）、阿片类药物减量率（每日吗啡当量每公斤的阿片类药物总量 [MEK]）、预减量时的 MEK 峰值、预减量时的 MEK 累积量、开始减量前的阿片类药物暴露天数以及年龄。
在 26 名入组的参与者中，仅有 9 名（45%）在任意一天出现阿片类药物戒断。此外，WAT-1 评分的变化有限。最常见的症状包括腹泻、呕吐、出汗和发热。
为了进行最佳的阿片类药物戒断评估，临床医生应使用 WAT-1 等经过验证的工具来测量阿片类药物戒断的症状和体征。需要进一步研究以确定儿童阿片类药物戒断的风险因素。
