Department of Pharmacy and Division of Pediatric Critical Care, Children's Hospital Colorado, Aurora, CO.
Skaggs School of Pharmacy and Pharmaceutical Sciences, Department of Clinical Pharmacy, Anschutz Medical Campus, Aurora, CO.
Pediatr Crit Care Med. 2019 May;20(5):e240-e244. doi: 10.1097/PCC.0000000000001920.
To evaluate the effect of nalbuphine administration on urine output in critically ill children with opioid-associated urinary retention.
Institutional review board approved, single center, retrospective medical chart review.
Large medical-surgical PICU within a free-standing, tertiary care children's hospital.
Patients admitted to the PICU between October 1, 2014, and February 29, 2016, who received IV nalbuphine after meeting criteria for opioid-associated oliguria (defined as urine output below 1 mL/kg/hr and received at least one dose of opioid therapy within the preceding 12 hr).
None.
Seventeen patients who received 21 doses of nalbuphine were analyzed. The median age and weight of patients were 6 years (interquartile range, 3-11.5 yr) and 18 kg (interquartile range, 12-35 kg), respectively. Two distinct dosing strategies became evident, specifically 0.05 mg/kg (n = 11 doses) and 0.1 mg/kg (n = 10 doses). Urine output increased significantly from baseline (median, 0 mL/kg/hr; interquartile range, 0-0.53 mL/kg/hr) to 6 hours post nalbuphine administration (median, 1.48 mL/kg/hr; interquartile range, 0-2 mL/kg/hr; p = 0.0002). Patients who received 0.1 mg/kg/dose had a greater urine output response compared with those who received 0.05 mg/kg/dose. Five patients (29%) had a catheter inserted into their bladder after administration of nalbuphine. Pain scores (grouped 6 hr before and after nalbuphine administration and single pain scores documented immediately before and after nalbuphine administration) were unchanged.
Nalbuphine administration, at a dose of 0.1 mg/kg, improved urine output in a cohort of children with opioid-associated urinary retention. Pain control did not appear influenced by the provision of nalbuphine. Additional studies are needed to determine the influence of nalbuphine on urinary catheter insertion rates and catheter-associated urinary tract infections.
评估纳布啡给药对阿片类药物相关尿潴留危重症患儿尿量的影响。
机构审查委员会批准，单中心，回顾性病历审查。
一家独立的三级儿童医院内的大型外科儿科重症监护病房。
2014 年 10 月 1 日至 2016 年 2 月 29 日期间入住儿科重症监护病房的患者，符合阿片类药物相关少尿标准（定义为尿量低于 1ml/kg/hr 且在之前 12 小时内接受至少一剂阿片类药物治疗）后接受 IV 纳布啡治疗。
无。
分析了 17 例接受 21 剂纳布啡的患者。患者的中位年龄和体重分别为 6 岁（四分位距，3-11.5 岁）和 18kg（四分位距，12-35kg）。两种不同的给药策略变得明显，分别为 0.05mg/kg（n=11 剂）和 0.1mg/kg（n=10 剂）。纳布啡给药后 6 小时，尿量从基线（中位数，0ml/kg/hr；四分位距，0-0.53ml/kg/hr）显著增加（中位数，1.48ml/kg/hr；四分位距，0-2ml/kg/hr；p=0.0002）。接受 0.1mg/kg/剂剂量的患者与接受 0.05mg/kg/剂剂量的患者相比，尿量增加更为显著。5 例患者（29%）在纳布啡给药后插入了导尿管。疼痛评分（纳布啡给药前 6 小时分组和纳布啡给药前和后即刻记录的单次疼痛评分）无变化。
纳布啡给药，剂量为 0.1mg/kg，可改善阿片类药物相关尿潴留患儿的尿量。疼痛控制似乎不受纳布啡给药的影响。需要进一步研究以确定纳布啡对导尿管插入率和与导尿管相关的尿路感染的影响。
