在术后重症监护期间增加阿片类药物使用的危险因素
Lauriane Guichard1,2,3, Milo C Engoren2, Yi-Ju Li4
1Duke University Department of Anesthesiology and Critical Care Medicine, Critical Care and Perioperative Population Health Research (CAPER) Group, Durham, NC.
Critical care explorations
|October 28, 2024
概括
机械通风和先前的阿片类药物使用是ICU中术后阿片类药物消费的关键预测因素. 在这项研究中,心理因素和遗传学并没有显著影响阿片类药物的使用.
科学领域:
- 密集护理医学 密集护理医学
- 药物基因组学 药物基因组学
- 外科手术的结果
背景情况:
- 阿片类药物对于ICU的疼痛管理和呼吸机耐受性至关重要.
- 识别阿片类药物消费的预测因素可以指导减少阿片类药物使用的战略.
- 手术后的ICU停留通常涉及大量的阿片类药物管理.
研究的目的:
- 确定在术后重症监护室 (ICU) 设置中与阿片类药物使用相关的风险因素.
- 调查手术前,手术内和遗传因素对阿片类药物消费的影响.
主要方法:
- 1865名混合手术患者的前性观察队列研究.
- 收集的数据包括手术前问卷 (社会人口统计学,健康) 和遗传分析.
- 主要结局:通过线性回归分析每日口服吗啡等效 (OME) 使用的平均值.
主要成果:
- 机械通风 (效果大小1.85) 和手术前使用阿片类药物 (效果大小1.67) 是OME的最强预测因素.
- 大型手术 (效果大小1.62) 和非法药物使用 (效果大小1.30) 也显著预测了OME.
- 遗传变异 (FKBP5,COMT,OPRM1) 没有与OME相关.
结论:
- 机械通风和术前阿片类药物使用是术后ICU阿片类药物消费的主要驱动因素.
- 心理因素和特定的遗传变异似乎不是重要的预测因素.
- 研究结果表明,专注于通风管理和手术前阿片类药物史,以减轻ICU阿片类药物使用.
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