Suchovsky Skyler B, Reiter Pamela D, Lewis Hannah E, Clevenger Amy C
Department of Pharmacy (SBS, HEL), Children's Hospital Colorado, Anschutz Medical Campus, Aurora, CO.
Department of Pharmacy and Division of Pediatric Critical Care (PDR), Children's Hospital Colorado.
J Pediatr Pharmacol Ther. 2022;27(4):373-378. doi: 10.5863/1551-6776-27.4.373. Epub 2022 May 9.
To evaluate the association between methylnaltrexone and urine output (UOP) in critically ill children with opioid-associated urinary retention.
This retrospective study included patients admitted to the pediatric intensive care unit between December 1, 2019, and November 30, 2020, who received methylnaltrexone for opioid-associated oliguria (spontaneous UOP below 1 mL/kg/hr and at least 1 dose of an opioid within the preceding 6 hours).
Twenty-five patients (median age = 5.5 years, IQR 1.7-16.4; median weight = 19 kg, IQR 9-45) were included. Mean methylnaltrexone dose was 0.15 ± 0.006 mg/kg. A statistically significant increase in UOP from baseline to 6 hours following methylnaltrexone was observed (p = 0.001), but not all patients responded. Fourteen patients (56%) had no UOP following methylnaltrexone administration, while 11 (44%) demonstrated a robust increase (median = 0 mL/kg/hr at baseline [IQR 0-0] to 1.96 mL/kg/hr [IQR 1.08-2.22; p = 0.001]) within 6 hours following methylnaltrexone administration. Younger patients responded better than older patients (responder age = 2.5 years [IQR 0.8-7]) versus 11.4 years [IQR 1.75-17.5] for non-responders) (p = 0.04). Both intravenous (IV) and subcutaneous (SQ) routes were associated with an increase in UOP (IV, p = 0.04; SQ, p = 0.02). The effect persisted for up to 24 hours after administration. Sixty-four percent of patients required urinary catheter placement. Pain scores (averaged 6 hours before and after methylnaltrexone) remained unchanged (p = 0.44).
Methylnaltrexone may increase spontaneous UOP in some children with opioid-associated urinary retention, but urinary catheterization rates remain high.
评估甲基纳曲酮与患有阿片类药物相关性尿潴留的危重症儿童尿量（UOP）之间的关联。
这项回顾性研究纳入了2019年12月1日至2020年11月30日期间入住儿科重症监护病房、因阿片类药物相关性少尿（自发尿量低于1 mL/kg/小时且在之前6小时内至少使用过1剂阿片类药物）而接受甲基纳曲酮治疗的患者。
共纳入25例患者（中位年龄 = 5.5岁，四分位间距1.7 - 16.4；中位体重 = 19 kg，四分位间距9 - 45）。甲基纳曲酮的平均剂量为0.15±0.006 mg/kg。观察到从基线到甲基纳曲酮给药后6小时尿量有统计学意义的增加（p = 0.001），但并非所有患者都有反应。14例患者（56%）在给予甲基纳曲酮后无尿量增加，而11例（44%）在给予甲基纳曲酮后6小时内尿量有显著增加（基线时中位值 = 0 mL/kg/小时[四分位间距0 - 0]至1.96 mL/kg/小时[四分位间距1.08 - 2.22；p = 0.001]）。年龄较小的患者比年龄较大的患者反应更好（有反应者年龄 = 2.5岁[四分位间距0.8 - 7]，无反应者年龄为11.4岁[四分位间距1.75 - 17.5]）（p = 0.04）。静脉注射（IV）和皮下注射（SQ）途径均与尿量增加相关（IV，p = 0.04；SQ，p = 0.02）。给药后该效应可持续长达24小时。64%的患者需要放置导尿管。疼痛评分（甲基纳曲酮给药前后平均6小时）保持不变（p = 0. '44）。
甲基纳曲酮可能会增加一些患有阿片类药物相关性尿潴留儿童的自发尿量，但导尿率仍然很高。
