Hauch Holger, Lisakowski Annika, Wager Julia, Zernikow Boris
Pediatric Palliative Care Centre, Children's and Adolescents' Hospital Datteln, 45711 Datteln, Germany.
Department of Children's Pain Therapy and Pediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58455 Witten, Germany.
Children (Basel). 2024 Aug 28;11(9):1054. doi: 10.3390/children11091054.
BACKGROUND/OBJECTIVES: Patients with life-limiting conditions (LLCs) often suffer from restlessness, spasticity, pain, and seizures. Dronabinol (DRB) may have a relieving effect; however, data on the effectiveness of DRB in children with LLCs are limited to outpatients. The aim of this study was to assess the efficacy and safety of DRB.
Retrospective analysis of inpatients.
From 2011 to 2021, 1219 patients were admitted. Of these, 63 patients (63.5% male, age: 10.4 (SD = 6.3) years) were treated with DRB; 96.8% had a neurological disease, and 26 patients were started on DRB (group A), while 37 were admitted with existing DRB (group B). The effective doses were 0.21 (SD = 0.11) in group A and 0.48 (SD = 0.5) mg/kg/BW/day in group B ( = 0.01). Subjective response rates to DRB in both groups (good/moderate effect) were 9.5%/38.1% for spasticity and 1.6%/25.4% for restlessness. However, no reduction in seizures, restlessness, or demand medication was observed in 24 h protocols when patients started DRB in group A. Three patients experienced severe side effects (e.g., respiratory depression). Other side effects included fatigue (22.2%) and behavioral problems (14.3%).
Subjective positive effects could not be confirmed by more objective data. Side effects can be severe. Thus, DRB should be started in a well-monitored setting and only with clear indications.
背景/目的：患有危及生命疾病（LLCs）的患者常伴有躁动、痉挛、疼痛和癫痫发作。屈大麻酚（DRB）可能具有缓解作用；然而，关于DRB对患有LLCs儿童有效性的数据仅限于门诊患者。本研究的目的是评估DRB的疗效和安全性。
对住院患者进行回顾性分析。
2011年至2021年期间，共收治1219例患者。其中，63例患者（63.5%为男性，年龄：10.4（标准差 = 6.3）岁）接受了DRB治疗；96.8%患有神经系统疾病，26例患者开始使用DRB（A组），37例患者入院时已使用DRB（B组）。A组的有效剂量为0.21（标准差 = 0.11），B组为0.48（标准差 = 0.5）mg/kg/体重/天（P = 0.01）。两组对DRB的主观反应率（良好/中等效果），痉挛方面分别为9.5%/38.1%，躁动方面分别为1.6%/25.4%。然而，A组患者开始使用DRB时，在24小时的观察记录中未观察到癫痫发作、躁动或用药需求的减少。3例患者出现严重副作用（如呼吸抑制）。其他副作用包括疲劳（22.2%）和行为问题（14.3%）。
主观积极效果无法通过更客观的数据得到证实。副作用可能很严重。因此，应在密切监测的情况下开始使用DRB，且仅在有明确指征时使用。
