在注射阿片类药物成的患者中感染性内心炎
Michael J Javorski1, Brad F Rosinski1, Shawn Shah1
1Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, USA.
Journal of the American College of Cardiology
|February 21, 2024
概括
在注射毒品的人中,感染性内心炎的手术死亡率很低,但成仍然是一个致命的威胁. 改进的成策略至关重要,以防止失去后续和复发.
科学领域:
- 心脏病学 心脏病学
- 传染性疾病 传染性疾病
- 成 药物 药物 药物 药物
背景情况:
- 由于感染性内心炎而接受手术的注射药物使用者 (PWID) 面临高死亡风险.
- 目前的手术后康复不足以防止在这个人群中失去随访,复发和死亡.
研究的目的:
- 描述感染性内心炎的PWID中药物使用模式,心理社会问题和手术结果.
- 为了确定术后失去随访,注射药物使用复发和死亡率的风险因素.
- 在这个患者群体中评估成管理策略.
主要方法:
- 在2010年1月至2020年6月期间接受了感染性内心炎手术的227名PWID的回顾性研究.
- 对药物使用,心理社会因素,手术结果和术后随访数据的分析.
- 参数学和机器学习方法被用来确定风险因素对竞争风险的损失后续,复发和死亡的风险.
主要成果:
- 海洛因是最常见的注射药物 (81%). 观察到高率的心理社会问题,包括无家可归 (25%) 和司法系统参与 (66%).
- 在医院的死亡率很低 (1.8%). 在5年后的术后条件概率是:失去随访 (59%),复发 (79%) 和死亡率 (68%).
- 年龄较小,海洛因使用和教育水平较低预测复发. 药物治疗阿片类药物使用障碍在出院时增加到100%到2020年.
结论:
- 在PWID中,感染性内心炎的手术可以达到较低的死亡率,但成的致命性仍然存在.
- 失去随访和复发的重大风险凸显了需要加强成治疗策略的需要.
- 有效的干预措施对于减轻与这种患者群体相关的社会损失至关重要.
相关概念视频
Pulmonary Tuberculosis I
243
Tuberculosis, often called TB, is a contagious illness primarily caused by Mycobacterium tuberculosis. It mainly affects the lung parenchyma but can also impact other body parts.
Causative Organism
The primary infectious agent causing tuberculosis is Mycobacterium tuberculosis, a slow-growing, acid-fast, aerobic rod that exhibits sensitivity to heat and ultraviolet light. Instances of Mycobacterium bovis and Mycobacterium avium contributing to the development of TB infection are rare.
Mode of...
Causative Organism
The primary infectious agent causing tuberculosis is Mycobacterium tuberculosis, a slow-growing, acid-fast, aerobic rod that exhibits sensitivity to heat and ultraviolet light. Instances of Mycobacterium bovis and Mycobacterium avium contributing to the development of TB infection are rare.
Mode of...
243
Drug Abuse and Addiction: Pharmacological Phenomena
476
Drug dependence, abuse, and addiction are complex phenomena that can precipitate various abnormal states. Physical dependence refers to a state of pharmacological adaptation to a drug. This adaptation often results in tolerance—a reduced response to the drug after repeated administrations. When the drug use is abruptly stopped, withdrawal symptoms occur due to the body's need to readjust from the pharmacologically induced imbalance. However, tolerance and withdrawal symptoms do not...
476
Analgesia and Pain Management
623
Pain is critical to various clinical pathologies, provoking an urgent need for effective management. Pain, whether acute or chronic, is a complex neurochemical process. Its alleviation depends on the type, with nonopioid analgesics effective for mild to moderate pain, such as musculoskeletal or inflammatory pain, while neuropathic pain responds best to anticonvulsants, tricyclic antidepressants, or serotonin/norepinephrine reuptake inhibitors. For severe acute or chronic pain, opioids may be...
623
Opioid Analgesics: Synthetic and Semisynthetic Opioids
299
Synthetic and semisynthetic opioids are pivotal in pain management and tackling opioid addiction. Semisynthetic opioids, including morphinans (morphine derivatives), oxycodone, oxymorphone, hydrocodone, and hydromorphone, have improved pharmacokinetic profiles compared to morphine. Additionally, heroin and 6-MAM (6-Monoacetylmorphine) show better CNS penetration than morphine due to heightened lipid solubility. Hydromorphone, a potent opioid, undergoes hepatic metabolism to form the active...
299
Healthcare Associated Infections I: Iatrogenic, Exogenic and Endogenic
4.2K
Healthcare-associated infections (HAIs) occur in a healthcare facility while a person receives care for another ailment. This category also includes work-related infections among healthcare staff.
HAIs significantly increase the cost of health care. Extended stays in healthcare institutions, increased disability, increased costs of medications, including specialized antibiotics, and prolonged recovery times add to the patient's expenses and the healthcare institution and funding bodies.
HAIs significantly increase the cost of health care. Extended stays in healthcare institutions, increased disability, increased costs of medications, including specialized antibiotics, and prolonged recovery times add to the patient's expenses and the healthcare institution and funding bodies.
4.2K
Opioid Analgesics: Morphine and Other Natural Cogeners
250
Opioids are a class of drugs that mimic endogenous opioid peptides and act on opioid receptors, and help in pain relief. These compounds are classified as natural, synthetic, or semi-synthetic. Natural opioids, like morphine, codeine, and thebaine, are derived from the opium poppy plant (Papaver somniferum or Papaver album) and are termed opiates. Synthetic opioids are artificial, while semi-synthetic opioids combine natural and synthetic compounds. Morphine, a prototypical opioid, possesses a...
250


