在胸部手术中使用阿片类药物:对术后并发症的回顾性研究
Jerry Xiao1, Duc T Nguyen2, Zoe K Lichtenberg3
1Department of Surgery, Houston Methodist Hospital, Houston, TX, USA.
Journal of thoracic disease
|November 18, 2024
概括
在接受胸部手术的患者中,更高的住院阿片类药物使用与术后并发症的增加有关. 降低阿片类药物剂量可能会改善手术结果.
科学领域:
- 胸部外科手术 胸部外科手术
- 疼痛管理 疼痛管理
- 手术后增强恢复 (ERAS) 计划
背景情况:
- 阿片类药物对于治疗术后疼痛至关重要,但它们的使用正在通过手术后康复 (ERAS) 计划减少.
- 这项研究研究了医院内阿片类药物消费与手术后并发症在具有强有力的ERAS计划的外科实践中的关联.
研究的目的:
- 确定医院内阿片类药物使用与胸部外科手术后术后并发症的发生之间的关系.
- 确定与增加并发症风险相关的总和平均每日阿片类药物剂量的最佳切断点.
主要方法:
- 在2020年11月至2021年11月期间,对419名接受胸部手术的患者进行了回顾性嵌套病例控制研究.
- 分析了吗啡毫克等效 (MME) 数据,比较有并发症和没有并发症的患者,使用后勤回归和ROC曲线分析.
主要成果:
- 经历术后并发症的患者的中位数MME总量 (135毫克 vs. 70毫克) 和每日MME均值显著更高.
- 使用阿片类药物,总MME≥241毫克或每日MME≥60毫克与明显更高的并发症可能性有关.
- 多变量分析确定了西班牙裔种族,更长的手术持续时间和更高的MME总数作为并发症的独立风险因素.
结论:
- 住院阿片类药物消费与胸部手术患者的术后并发症增加有关.
- 在住院期间服用的阿片类药物的总量成为不良结果的独立风险因素.
- 通过多式,非阿片类药物疼痛管理策略来最大限度地减少阿片类药物的使用,可能会改善手术恢复和患者的结果.
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