Lardieri Allison B, Fusco Nicholas M, Simone Shari, Walker L Kyle, Morgan Jill A, Parbuoni Kristine A
Department of Pharmacy Practice and Science, School of Pharmacy, University of Maryland, Baltimore, Maryland.
School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, New York.
J Pediatr Pharmacol Ther. 2015 Jan-Feb;20(1):45-53. doi: 10.5863/1551-6776-20.1.45.
To compare withdrawal symptoms among pediatric intensive care patients receiving clonidine to those not receiving clonidine while being weaned from long-term dexmedetomidine.
This retrospective analysis evaluated Withdrawal Assessment Tool-1 (WAT-1) scores and hemodynamic parameters in pediatric patients on dexmedetomidine for 5 days or longer between January 1, 2009, and December 31, 2012. The primary objective was to compare withdrawal symptoms based on the number of elevated WAT-1 scores among patients on clonidine to those not on clonidine, while being weaned from long-term dexmedetomidine. The secondary objective was to describe withdrawal symptoms associated with long-term dexmedetomidine use.
Nineteen patients (median age, 1.5 years; interquartile range [IQR], 0.67-3.3) received 20 treatment courses of dexmedetomidine for at least 5 days. Clonidine was received by patients during 12 of the treatment courses. The patients in the clonidine group had an average of 0.8 (range, 0-6) elevated WAT-1 scores 24 hours post wean compared to an average of 3.2 (0-8) elevated WAT-1 scores in the no clonidine group (p = 0.49). There were no significant difierences between prewean and postwean systolic or diastolic blood pressures among the 2 groups. The average heart rate during the postwean period was 112 beats per minute (bpm) (range, 88.5-151.5) in the clonidine group compared to 138.4 bpm (range, 117.8-168.3) in the no clonidine group (p = 0.003). In the clonidine group, the mean change in heart rate postwean compared to prewean was an increase of 3.6 bpm (range, -39.6 to 47.5), compared to a mean increase of 29.9 bpm (range, 5.5-74.7) in the no clonidine group (p = 0.042).
There was no difierence in WAT-1 scores between groups, with the clonidine group displaying a trend towards fewer elevated WAT-1 scores during the 24 hours post dexmedetomidine wean. Patients who received clonidine had significantly lower heart rates than the no clonidine group.
比较在从长期右美托咪定撤药过程中，接受可乐定治疗的儿科重症监护患者与未接受可乐定治疗的患者的戒断症状。
这项回顾性分析评估了2009年1月1日至2012年12月31日期间使用右美托咪定5天或更长时间的儿科患者的戒断评估工具-1（WAT-1）评分和血流动力学参数。主要目的是比较在从长期右美托咪定撤药过程中，根据可乐定使用情况，WAT-1评分升高的患者数量所反映的戒断症状。次要目的是描述与长期使用右美托咪定相关的戒断症状。
19名患者（中位年龄1.5岁；四分位间距[IQR]为0.67 - 3.3）接受了20个疗程的右美托咪定治疗，疗程至少5天。其中12个疗程的患者接受了可乐定治疗。可乐定组患者在撤药后24小时的WAT-1评分平均升高0.8（范围0 - 6），而未使用可乐定组的WAT-1评分平均升高3.2（0 - 8）（p = 0.49）。两组撤药前和撤药后的收缩压或舒张压无显著差异。撤药后期间，可乐定组的平均心率为每分钟112次（bpm）（范围88.5 - 151.5），未使用可乐定组为138.4 bpm（范围117.8 - 168.3）（p = 0.003）。在可乐定组中，撤药后与撤药前相比，心率平均变化为增加3.6 bpm（范围 - 39.6至47.5），而未使用可乐定组平均增加29.9 bpm（范围5.5 - 74.7）（p = 0.042）。
两组之间WAT-1评分无差异，可乐定组在右美托咪定撤药后24小时内WAT-1评分升高的趋势较小。接受可乐定治疗的患者心率显著低于未使用可乐定组。
