心脏手术中的阿片类药物剂量变化:一项多中心实践研究
Clark Fisher1, Allison M Janda2, Xiwen Zhao3
1From the Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut.
Anesthesia and analgesia
|August 21, 2024
概括
高剂量的阿片类药物在心脏手术中很常见,患者之间存在显著差异. 麻醉师的实践模式,而不是患者因素,在很大程度上推动了这些阿片类药物剂量差异,这表明了优化机会.
科学领域:
- 麻醉学 麻醉学
- 心脏外科手术 心脏外科手术
- 药理学 药理学是指药理学的学科.
背景情况:
- 高阿片类麻醉在历史上是心脏手术的标准.
- 目前的趋势是探索多模式止痛和低阿片类药物技术.
- 典型的阿片类药物剂量和影响心脏手术的因素仍然不清楚.
研究的目的:
- 在成人心脏手术中确定典型的手术内阿片类药物剂量.
- 调查患者,麻醉师和机构因素对阿片类药物剂量变化的影响.
- 确定优化心脏外科手术中阿片类药物使用的机会.
主要方法:
- 对非紧急成人心脏手术需要心肺旁路术 (2014-2021) 的回顾性审查.
- 数据来自30个学术和社区医院在多中心外科外科术期结果组注册表.
- 层次线性建模来分析因机构,麻醉师,患者和病例特征而产生的阿片类药物剂量变化.
主要成果:
- 在59,463个案例中,平均使用了1139毫克芬太尼相当的阿片类药物.
- 观察到显著的剂量变化 (SD,872μg);60%的变化是由机构和麻醉师解释的.
- 麻醉师的阿片类药物剂量与sufentanil输液使用相关 (r=0.81),但非阿片类药物止痛技术没有相关性 (我用阿片类药物<0.3).
结论:
- 高剂量的阿片类药物在心脏外科手术中仍然普遍存在,并表现出相当大的个体差异.
- 机构和麻醉师之间的实践变化,而不是患者或手术因素,占了这种变化的大部分.
- 在心脏手术麻醉中优化阿片类药物的利用有很大的机会.
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