在新西兰手术后入院后持续使用阿片类药物:基于人口的研究
Jiayi Gong1, Peter Jones2, Chris Frampton3
1From the School of Pharmacy, The University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand.
Anesthesia and analgesia
|March 17, 2024
概括
在新西兰手术后,大约9.1%的未使用过阿片类药物的患者出现了持续的阿片类药物使用 (POU). 可修改的处方因素,如改变阿片类药物,多次阿片类药物处方和更高剂量增加了POU风险.
科学领域:
- * 人口健康 人口健康
- * 药物监督 * 药物监督 *
- * 手术的结果
背景情况:
- *持续使用阿片类药物 (POU) 是手术后的一个重大问题,与死亡率和发病率的增加有关.
- * 在新西兰 (NZ) 的未使用过阿片类药物的外科手术患者中存在有限的基于人口的POU数据.
研究的目的:
- * 确定在新西兰接受手术的未使用过阿片类药物患者中POU的发病率.
- * 为了确定该人群中与POU相关的风险因素.
主要方法:
- * 在新西兰医院接受手术的阿片类药物未使用患者的回顾性队列研究 (2007-2019).
- *未使用阿片类药物的状态,定义为在手术前365天内没有先前的阿片类药物开放或阿片类药物使用障碍诊断.
- *POU定义为退院后91至365天间的阿片类药物使用;用于风险因素分析的多变量逻辑回归.
主要成果:
- * 在260,726名符合条件的未使用过阿片类药物的外科手术患者中,9.1%的人患有POU.
- *增加POU风险的处方因素:退院后更换阿片类药物 (aOR 3.21),多种阿片类药物 (aOR 1.37) 和更高的口服总摩尔类药物 (aOR 1.23)
- *与增加POU相关的因素:神经外科手术 (aOR 2.02),高并发病率 (aOR 1.90),手术前使用非阿片类止痛药 (aOR 1.65),吸烟 (aOR 1.44) 和催眠使用 (aOR 1.35). 同处方非阿片类止痛药降低了POU的风险 (aOR 0.91).
结论:
- *近11名未使用过阿片类药物的患者中,有近1名在手术后服用阿片类药物的患者出现POU.
- *可修改的处方因素,包括阿片类药物转换,多药和高初始剂量,显著影响POU的发展.
- * 临床医生应就POU风险向患者提供建议,并在处方术后止痛时考虑可修改的因素.
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