尾切除术 疼痛药物 处方变化 在美国军事卫生系统
William A Cronin1,2, Matthew D Nealeigh3,4, Nathaniel M Harry1
1Department of Anesthesiology, Walter Reed National Military Medical Center, 4494 Palmer Rd N, Bethesda, MD 20814, USA.
尾切除术后的阿片类药物排放剂量在军事卫生系统中是推水平的两倍,与补充概率无关. 诸如复杂的尾炎和心理健康诊断等因素增加了补充可能性,而安全政策减少了它.
科学领域:
- 药理学和卫生服务研究 研究 药理学和卫生服务研究
- 手术结果和疼痛管理
背景情况:
- 尾切除术后的阿片类药物处方在医疗保健系统之间有很大差异.
- 现有的指导方针主张保守的阿片类药物使用和非阿片类药物替代品.
- 在美国军事卫生系统 (MHS) 中,尾切除术后的处方模式和补充概率以前没有被描述.
研究的目的:
- 在MHS内分析尾切除术后的阿片类药物处方实践.
- 确定影响离院时吗啡等效剂量 (MED) 和30天阿片类药物补充概率的因素.
- 评估国防卫生署 (DHA) 的阿片类药物安全政策对处方的影响.
主要方法:
- 对11713名尾切除术患者进行的回顾性观察队列研究 (2016年1月 - 2021年6月).
- 利用线性混合和通用线性混合模型来评估患者,护理和系统级因素.
- 主要结局:出院时的MED和30天阿片类药物处方补充的概率;进行了敏感性分析.
主要成果:
- 排放MED的平均值是推指南的两倍,与补充可能性无关.
- 与阿片类药物/非阿片类药物的组合,缺乏非阿片类药物的使用,DHA前的政策照顾,尼古丁依赖和先前的阿片类药物的使用相关的更高的MED排放.
- 阿片类药物补充更有可能导致复杂的尾炎,女性性别,心理健康诊断,抗抑郁药物使用和尼古丁依赖;在DHA政策实施后和对阿片类药物未使用的患者来说,这种可能性更小.
结论:
- 虽然个人处方调整为新的指导方针,阿片类药物剂量的不合理变化仍然存在.
- 超出临床需要的因素似乎影响了处方和补充行为.
- 未来的研究应该专注于患者的体验,满意度和教育,以规范护理和优化疼痛管理.
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