早期的阿片类药物使用和术后妄想,在腹腔大动脉动脉瘤开放修复后
Richard D Gutierrez1, Lejla Pepic1, Elizabeth M Lancaster1
1Department of Surgery, University of California, San Francisco, San Francisco, CA.
Annals of vascular surgery
|July 28, 2024
概括
在开放腹腔大动脉动脉瘤修复后,高早期阿片类药物的使用增加了术后妄想的风险. 诸如外围注射和乙氨基的使用等策略可以减少阿片类药物需求,可能降低妄想率.
科学领域:
- 血管外科 血管外科
- 麻醉学 麻醉学
- 老年医学 老年医学
背景情况:
- 手术后痴呆症是腹腔大动脉动脉瘤开放修复 (OAR) 后的常见并发症.
- 阿片类止痛药,特别是高剂量的阿片类止痛药,与妄想症的发展有关.
- 早期术后阿片类药物消费对妄想的影响需要进一步调查.
研究的目的:
- 评估早期术后阿片类药物止痛与术后狂妄症发生率之间的关联.
- 评估早期阿片类药物使用对术后妄想发作的时间的影响.
- 测试假设,较高的早期阿片类药物利用与 Delirium 发病率的增加相关.
主要方法:
- 194个OAR案件 (2012-2020年) 的回顾性分析.
- 主要暴露:手术后1-7天的口服吗啡相当量 (OME).
- 通过ROC分析确定高OME值 (>37毫克);使用多变量后勤回归.
主要成果:
- 67%的患者患有妄想,平均发病时间为3天.
- 在术后第一天使用高OME与 Delirium 发病率增加有关 (42%对25%).
- 外周治疗与减少早期的OME和较晚的妄想发作相关.
结论:
- 提升的早期术后阿片类药物使用与更高的 Delirium 发病率有关.
- 除外注射和乙氨基的使用可能会降低阿片类药物需求.
- 对阿片类药物节约策略的进一步研究对于主要血管外科手术的结果是有必要的.
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