在慢性疼痛患者中长期使用阿片类药物和痴呆风险
Mingyang Sun1, Wan-Ming Chen2, Szu-Yuan Wu3
1Department of Anesthesiology and Perioperative Medicine, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Zhengzhou, Henan, China.
Journal of the American Medical Directors Association
|August 7, 2023
概括
慢性疼痛患者长期使用阿片类药物与更高的痴呆风险有关. 这表明,由于潜在的认知影响,需要仔细监测和处方阿片类药物.
科学领域:
- 神经科学是一个神经科学.
- 药理学 药理学是指药理学的学科.
- 流行病学 流行病学
背景情况:
- 慢性疼痛影响人口的很大一部分,经常通过长期的阿片类药物治疗来控制.
- 阿片类止痛药被广泛处方,引发了人们对其长期安全性和对认知功能的潜在不良影响的担忧.
- 痴呆症是一个日益严重的公共卫生问题,识别可修改的风险因素对于预防策略至关重要.
研究的目的:
- 调查持续使用阿片类药物与随后患痴呆症的风险之间的关联.
- 为了比较使用阿片类药物的慢性疼痛患者与不使用阿片类药物的慢性疼痛患者的痴呆发病率.
- 在长期阿片类药物治疗的背景下,确定痴呆风险的潜在预测因素.
主要方法:
- 采用了倾向分数匹配 (PSM) 的比较队列研究设计.
- 利用时间变化的考克斯回归分析来评估痴呆风险,计算调整的危险比率 (aHR) 和95%置信区间 (CI).
- 包括41,636名PSM后患者,20,968名长期阿片类药物组 (≥180定义的每日剂量/年) 和20,968名非阿片类药物组.
主要成果:
- 长期使用阿片类药物的人患痴呆的风险显著增加,调整后危险比率 (aHR) 为1.86 (95% CI 1.25-2.09; P < .001).
- 与非阿片类药物组相比,阿片类药物组中痴呆的发病率较高 (44.09 / 10,000 人/年),而非阿片类药物组的发病率较高 (38.85 / 10,000 人/年).
- 调整后的发病率为1.13 (95% CI:1.07-1.21,P <.001),进一步支持了与长期使用阿片类药物相关的痴呆风险增加.
结论:
- 长期使用阿片类药物可能与治疗慢性疼痛的个体痴呆的风险增加有关.
- 这些发现强调了明智的阿片类药物处方和对长期阿片类药物治疗患者认知变化的警监测的重要性.
- 需要进一步的研究来阐明这种关联背后的机制,并为治疗疼痛和预防痴呆症的临床指南提供信息.
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