糖尿病人的脚痛-抑郁周期
Brandon M Brooks1, Chia-Ding Shih2, Bradley M Brooks3
1*The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH; Wm. Jennings Bryan Dorn VA Medical Center, Columbia, SC.
Journal of the American Podiatric Medical Association
|July 18, 2023
概括
使用抗抑郁药的2型糖尿病 (T2DM) 患者在前脚截肢7天后需要阿片类药物的几率明显降低. 这表明抑郁症和糖尿病足疼痛管理之间存在联系.
科学领域:
- 足部医学是一门专业.
- 糖尿病学 糖尿病学
- 疼痛管理 疼痛管理
- 心理健康 心理健康
背景情况:
- 每年有超过86,000名患有2型糖尿病 (T2DM) 的美国人接受下肢截肢.
- 对T2DM患者的足部外科手术中阿片类药物处方实践的研究不足.
- 抗抑郁药的使用可能会影响截肢的T2DM患者的术后阿片类药物持续时间.
研究的目的:
- 为了调查抗抑郁药物使用与手术后阿片类药物使用的持续时间之间的联系,在T2DM患者进行前脚截肢.
- 在这个患者群体中确定影响阿片类药物使用超过7天的因素.
主要方法:
- 对T2DM患者进行前脚截肢的回顾性队列研究 (脚,射线,转脚).
- 纳入标准:血红蛋白A1c<8.0%和脚-手腕指数>0.8.
- 后勤回归模型分析了超过7天的阿片类药物使用概率,考虑了抗抑郁药物使用,年龄,种族,性别,截肢水平,BMI和婚姻状况等变量.
主要成果:
- 50名患者符合研究标准.
- 抗抑郁药的使用是与减少阿片类药物使用相关的统计学上显著因素.
- 使用抗抑郁药的患者在截肢后7天内使用阿片类药物的几率显著降低 (OR,0.018;P = .002),即使在对婚姻状况进行调整后也是如此.
结论:
- 在T2DM患者的前脚截肢后,抗抑郁药的使用与长期阿片类药物的使用显著减少有关.
- 一个潜在的糖尿病脚痛-抑郁循环值得考虑.
- 对于治疗截肢的T2DM患者的足部外科医生来说,建议进行抑郁症和心理健康转诊的术前和术后查.
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