グルカゴンのようなペプチド1受容体アゴニストと手術前アスピレーションリスク
Cindy N Ho1, Alessandra T Ayers1, Michael A Kohn2
1Diabetes Technology Society, Burlingame, CA 94010, USA.
Journal of the Endocrine Society
|September 2, 2025
まとめ
グルカゴン類ペプチド1受容体アゴニスト (GLP- 1RAs) は,手術や内視鏡検査中に吸血リスクを増加させるようには見えません. 最近の研究では,GLP- 1RAの使用と吸気性肺炎との間に一貫した関連性が示されず,処置前に継続的に使用することを支持しています.
科学分野:
- 麻酔科
- 胃腸内科
- 薬理学について
背景:
- GLP- 1RAsによる胃の排泄が遅れたことは,手術中の吸入リスクに関する懸念を提起した.
- アメリカ麻酔学会 (American Society of Anesthesiologists,ASA) は当初,手術前にGLP-1RAの投与を中止することを推奨したが,後にこの勧告を撤回した.
- このレビューでは,最初のASAの勧告を支持または反論する証拠を検証します.
研究 の 目的:
- GLP-1RAの使用と吸血リスクとの関連に関する証拠を体系的に検討する.
- 選択的な外科的および内視的処置の前に,GLP- 1RAの継続的な使用の安全性を評価する.
主な方法:
- 遡及的なコホート研究の体系的レビュー.
- 2023年6月から2025年3月までの間に出版された研究をPubMedで検索した.
- GLP-1RA使用者と非使用者の間における吸入/肺炎の概要リスク比
主要な成果:
- 選択手術に関する3つの研究では,リスク比率が1. 00 [0. 76, 1. 30) であった.
- 内視鏡手術に関する4つの研究では,総合リスク比率は1. 10 [0. 95,1.27] であった.
- 類似した分析により,この方法論はオピオイド使用によるリスク増加を検出することが確認された (RR 2.68 [1.89, 3.81]).
結論:
- GLP-1RAは胃の排泄を遅らせているが,一貫して吸血リスクの増加と関連付けられていない.
- 実際の証拠は,手術や内視鏡検査において,GLP- 1RAに関連した重大な吸入リスクを支持しない.
- 大抵の患者は,選択的処置の前にGLP- 1RA治療を継続することができる.
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