血管外科手术后并发症与长期术后阿片类药物使用之间的关联
Luc Dubois1, J Andrew McClure2, Kelly Vogt3
1Department of Surgery, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada; ICES Western, London, Ontario, Canada.
Annals of vascular surgery
|October 6, 2023
概括
大型血管手术后,长期使用阿片类药物很常见,特别是在下肢再血管化 (LER) 后. 以前的阿片类药物使用是最强的预测因素,突出了针对性阿片类药物减少策略的需要.
科学领域:
- 血管外科 血管外科
- 疼痛管理 疼痛管理
- 药理学 药理学是指药理学的学科.
背景情况:
- 在重大血管手术后长期使用阿片类药物方面存在有限的研究.
- 没有研究探讨了主要并发症和长期使用阿片类药物之间的联系.
研究的目的:
- 为了调查与大血管手术后长时间使用阿片类药物相关的因素.
- 分析主要并发症和长期使用阿片类药物之间的关联.
主要方法:
- 在加拿大安大略省 (2013-2018) 进行基于人口的队列研究.
- 包括开放的下肢再血管化 (LER),内血管动脉瘤修复 (EVAR) 和开放的腹腔大动脉瘤修复 (AAA).
- 长期使用阿片类药物定义为 ≥2处方填满手术后6-12个月;使用修改Poisson回归分析.
主要成果:
- 长期使用阿片类药物观察到LER的26.1%,AAA的13.2%,以及11.6%的EVAR患者.
- 以前使用阿片类药物是最强的预测因素 (OR 4.69-13.27).
- 主要并发症在LER (OR 1.10) 中增加了长期使用风险,但在EVAR (OR 0.83) 中具有保护作用. 高龄降低了所有手术中长时间使用的风险.
结论:
- 长期使用阿片类药物在重大血管手术后普遍存在,特别是LER.
- 以前的阿片类药物使用是长期使用的关键预测因素.
- 针对高风险患者群体,建议针对性的多模式阿片类药物减少策略.
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