手术和创伤后新持续使用阿片类药物的发生率和危险因素:系统性审查
Jiayi Gong1, Peter Jones2, Amy Hai Yan Chan3
1School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand. Jay.gong@auckland.ac.nz.
BMC surgery
|July 16, 2024
概括
持久性阿片类药物使用 (POU) 是手术或创伤后对阿片类药物先验患者的担忧. 关键的风险因素包括并发症,精神健康问题,更长的住院时间和更高的阿片类药物剂量.
科学领域:
- 医学研究 医学研究
- 临床药理学 临床药理学
- 公共卫生 公共卫生
背景情况:
- 持续的阿片类药物使用 (POU) 可以在手术或创伤后发展.
- 现有的审查往往包括先前接触过阿片类药物的患者,这限制了对未使用阿片类药物的个体的相关性.
- 本综述的重点是以前没有服用过阿片类药物的患者,他们经历过手术或创伤.
研究的目的:
- 综合有关POU在先前未使用阿片类药物的患者手术后或创伤后发生的证据.
- 在这个特定的患者群体中确定与POU相关的风险因素.
主要方法:
- 在主要数据库 (Embase,Medline,CINAHL,Web of Science,Scopus) 进行系统的文献搜索,直到2023年7月.
- 包括接受手术或创伤的人类参与者的研究,重点关注阿片类药物使用和POU.
- 使用纽卡斯尔-太华尺度对队列研究进行偏差风险评估.
主要成果:
- 分析了22项研究 (20项手术,2项创伤),主要来自美国.
- 成人手术患者的POU发病率从3.9%到14.0%不等,儿童手术患者的POU发病率为2.0%.
- 确定的POU风险因素包括较高的并发症负担,先前存在的心理健康/慢性疼痛障碍,更长的住院时间和增加的阿片类药物剂量.
- 显著的异质性阻止了元分析.
结论:
- 研究的质量一般很好,尽管许多研究使用了美国的医疗行政数据.
- 确定了POU的一致风险因素,特别是在手术患者中.
- 对这些风险因素的认识可以帮助处方医生管理住院后的阿片类药物使用.
- 关于创伤患者的文献缺口为未来研究提供了机会.
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