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对于手术治疗死性肠球炎的婴儿,使用阿片类药物和甲
Olivia A Keane1,2, Abigail K Zamora1,2, Shadassa Ourshalimian1
1Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California.
JAMA network open
|June 22, 2023
概括
在为死角 enterokolitis (NEC) 接受手术的婴儿长期使用阿片类药物增加了甲治疗的可能性. 这影响了停留时间,通风和全腹腔营养 (TPN) 的使用.
科学领域:
- 新生儿手术 新生儿手术
- 儿科重症监护 儿科重症监护
- 药理学 药理学是指药理学的学科.
背景情况:
- 死性肠球炎 (NEC) 是早产新生儿手术干预的主要原因.
- 在这些脆弱的婴儿中,阿片类药物对于治疗术后疼痛至关重要.
- 一些婴儿会产生生理性阿片类药物依赖,需要甲治疗.
研究的目的:
- 分析手术后阿片类药物使用模式的婴儿与手术治疗NEC.
- 评估阿片类药物持续时间和甲治疗之间的关联.
- 评估甲使用对关键术后结果的影响.
主要方法:
- 一项回顾性队列研究分析了48家医院 (2013-2022) 中2037名经过手术治疗的NEC婴儿的数据.
- 排除标准包括手术前的甲,年龄超过14天,先天性心脏病手术或早期死亡率.
- 混合效应多变量后勤回归确定了与甲治疗和结果相关的因素.
主要成果:
- 11.3%的婴儿接受了美沙,通常在术后18日左右开始.
- 16-21天使用阿片类药物显著增加了甲治疗的几率 (OR 11.45).
- 甲使用与更长的住院时间 (+21.4天),呼吸机日数增加 (+10.8) 和更多的TPN日数 (+16.2) 相相关.
结论:
- 在术后的NEC婴儿中,长期使用非甲类阿片类药物与更高的甲使用有关.
- 甲治疗与延长住院时间和资源利用有关.
- 优化最初的疼痛管理可能会减少对甲的需求,并提高医疗保健的效率.
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