脏移植后成功的阿片类药物最小化:一种质量改善倡议
Sarah Bova1, Ron E Samet2, Jacob Deering3
1Department of Pharmacy, University of Maryland Medical Center, Baltimore, USA.
Cureus
|February 27, 2024
概括
一个新的阿片类药物最小化协议显著减少了住院患者的阿片类药物使用和脏移植患者的出院处方. 这种使用多式止痛和阻塞的方法改善了疼痛管理,但没有影响患者的治疗结果.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 移植手术 移植手术
- 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:
- 移植脏后的阿片类药物使用与增加的死亡率和移植损失有关.
- 多模式止痛和教育策略在减少阿片类药物消费方面表现有前途.
- 需要标准化的协议来优化疼痛管理,并尽量减少移植受体对阿片类药物的依赖.
研究的目的:
- 评估阿片类药物最小化协议对住院患者阿片类药物消费和出院处方实践的影响.
- 评估一项结合超声导向横腹平面 (TAP) 阻塞与计划非阿片类止痛药的方案的有效性.
主要方法:
- 一个单一中心的回顾性研究,将59名脏移植接受者 (后协议) 与52名前协议接受者 (2021年10月至2022年7月) 进行比较.
- 该方案涉及手术内TAP阻断剂,计划中的乙氨基和 gabapentin,以及必要时的特拉马多尔.
- 不包括在移植前服用慢性阿片类药物的患者;剂量根据功能障碍进行调整.
主要成果:
- 在治疗后观察到每天总住院吗啡毫克相当量 (MME) 的显著减少.
- 在后协议组中不需要患者控制的止痛装置 (PCA).
- 出院后的阿片类药物处方显著下降;没有疼痛评分,返回OR,再入院或停留时间的差异.
结论:
- 阿片类药物最小化协议有效地减少了脏移植患者的住院阿片类药物使用和出院处方.
- 有计划的乙氨基和 gabapentin,有或没有 TAP 阻断剂,使PCA 装置的消除成为可能.
- 这种多模式的方法实现了显著的阿片类药物减少,而不会影响患者报告的疼痛或关键的临床结果.
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