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在IBD手术后持续术后阿片类药物使用的危险因素:观察性队列研究
Viviane A Lin1, Rune P Hasselager, Tina Fransgaard
1Department of Surgery, Center for Surgical Science, Zealand University Hospital Køge, Køge, Denmark.
Diseases of the colon and rectum
|June 13, 2024
概括
接受手术的炎症性肠病 (IBD) 患者面临持续的术后阿片类药物使用的高风险. 关键的风险因素包括世卫组织表现不佳,手术前使用阿片类药物和精神病并发症,这凸显了最佳疼痛管理的必要性.
科学领域:
- 胃肠病学 胃肠病学
- 手术瘤学手术瘤学
- 疼痛管理 疼痛管理
背景情况:
- 患有炎症性肠病 (IBD) 的患者表现出持续使用阿片类药物的风险较高,手术干预发挥着重要作用.
- 了解导致手术后长期阿片类药物依赖的因素对于有效的IBD患者管理至关重要.
研究的目的:
- 在经过胃肠道手术的IBD患者中确定与持续的术后阿片类药物使用相关的风险因素.
- 描述这些患者在医院接受的阿片类药物治疗的模式.
主要方法:
- 进行了一项回顾性观察性队列研究.
- 收集了384名在2017年至2022年期间在大学医院接受IBD手术的患者的数据.
- 用多变量回归分析来确定基于手术前和住院特征的持续术后阿片类药物使用的几率比率 (ORs).
主要成果:
- 在9.4%的患者 (384人中36人) 观察到持续的术后阿片类药物使用.
- 确定的重大风险因素包括世卫组织绩效状态>1 (OR 8.21),手术前每日阿片类药物使用 (OR 12.84),精神病并发症 (OR 3.89),以及较高的住院平均每日阿片类药物使用 (OR 1.22/10MME增加).
- 只有2.9%的持续使用阿片类药物的患者在手术前没有服用阿片类药物.
结论:
- 在手术前使用阿片类药物,功能状况较差,精神病并发症和较高的住院阿片类药物消费是IBD患者持续术后使用阿片类药物的重要预测因素.
- 在IBD手术患者的手术前和后,建议优化疼痛管理策略,包括阿片类药物节约措施.
- 局限性包括单中心设计和由此产生的宽置信区间,需要进一步的多中心验证.
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