肝硬化患者接受肝切除的阿片类药物节约麻醉:一项受控随机双盲研究
Eman Sayed Ibrahim1,2,3, Ahmed A Metwally4, Mohamed Abdullatif5
1Department of Anaesthesiology, Intensive Care and Pain Management, National Liver Institute - Menoufia University, Menoufia, Egypt. emansayed825@gmail.com.
BMC anesthesiology
|February 1, 2025
概括
这项研究发现,结合胺和德克斯梅德托米丁输液可显著降低肝硬化患者接受肝切除的阿片类药物需求. 这种阿片类药物节约方法改善了术后疼痛,并减少了不良事件.
科学领域:
- 麻醉学 麻醉学
- 肝病学 肝病学是一种肝病学.
- 药理学 药理学是指药理学的学科.
背景情况:
- 在肝功能受损的患者中,阿片类药物代谢和药理动力学可能会发生变化.
- 胺和德克斯梅德托米丁是常用的麻醉剂.
- 在经过肝切除的肝硬化患者中,结合胺和德克斯梅德托米丁的阿片类药物节约潜力仍然未被评估.
研究的目的:
- 为了研究手术前期的片缓解效应,手术内注射的德克斯米德托米丁和胺注射.
- 为了评估这种组合在患有儿童甲肝硬化并接受肝切除的患者中.
主要方法:
- 一项随机对照双盲试验,涉及92名患有儿童A级肝硬化症的成年患者.
- 患者接受了胺和德克斯梅德托米丁输液 (阿片类药物节约组,OS) 或基于阿片类药物的麻醉 (对照组,OB).
- 结果包括手术期间和手术后的芬太尼消费,疼痛评分,恶心,吐,阴茎,脱,血液动力学事件和ICU停留.
主要成果:
- 在OS组显示显著降低了手术内芬太尼的消费 (183.2 ± 35.61μg vs 313.5 ± 75.06μg,P < 0.001).
- 经过48小时的术后芬太尼消耗在OS组中也明显较低 (354.5±112.62μg与779.1±294.97μg相比,P<0.001).
- 术后2小时,OS组的疼痛得分更好,不良事件更少,ICU停留时间更短.
结论:
- 在手术内注入德克斯米德托米丁和胺,在接受肝切除的儿童A肝硬化患者中提供显著的阿片类药物缓解效果.
- 这种方法使手术内阿片类药物使用量减少了约40%,手术后使用量减少了55%.
- 阿片类药物节约策略改善了术后结果,包括疼痛控制和减少副作用,导致ICU停留时间缩短.
相关概念视频
Local Anesthetics: Clinical Application as Spinal Anesthesia
572
Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...
572
Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy
39
Sigmoidoscopy and laparoscopy are distinct medical procedures that enable physicians to internally inspect different parts of the GI tract. Although they serve different purposes, each is essential for diagnosing and, in some cases, treating various medical conditions.
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...
39
Opioid Analgesics: Synthetic and Semisynthetic Opioids
211
Synthetic and semisynthetic opioids are pivotal in pain management and tackling opioid addiction. Semisynthetic opioids, including morphinans (morphine derivatives), oxycodone, oxymorphone, hydrocodone, and hydromorphone, have improved pharmacokinetic profiles compared to morphine. Additionally, heroin and 6-MAM (6-Monoacetylmorphine) show better CNS penetration than morphine due to heightened lipid solubility. Hydromorphone, a potent opioid, undergoes hepatic metabolism to form the active...
211
Parenteral Anesthetics: Overview
93
Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
93
Analgesia and Pain Management
443
Pain is critical to various clinical pathologies, provoking an urgent need for effective management. Pain, whether acute or chronic, is a complex neurochemical process. Its alleviation depends on the type, with nonopioid analgesics effective for mild to moderate pain, such as musculoskeletal or inflammatory pain, while neuropathic pain responds best to anticonvulsants, tricyclic antidepressants, or serotonin/norepinephrine reuptake inhibitors. For severe acute or chronic pain, opioids may be...
443


