剖腹产手术后增强恢复与产后阿片类药物使用协议的关联:质量改善项目的分析
Kathleen M Antony1, India Anderson-Carter2, Aimee Teo Broman3
1Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, kantony@wisc.edu.
实施手术后增强恢复 (ERAS) 协议在剖腹产分娩患者中显著减少了93.8%的阿片类药物使用. 这种协议,包括内吗啡,为产后疼痛管理提供了一种更安全的方法.
科学领域:
- 产科和妇科 产科和妇科
- 麻醉学 麻醉学
- 疼痛管理 疼痛管理
背景情况:
- 剖腹产患者经常经历高系统性阿片类药物利用.
- 慢性阿片类药物使用可能发生在50到300名患者中的1名急性疼痛治疗后.
- 剖腹产后的疼痛管理需要有效的策略来最大限度地减少阿片类药物依赖.
研究的目的:
- 评估标准化手术后增强恢复 (ERAS) 协议对剖腹产产后阿片类药物利用的影响.
- 为了确定ERAS的实施是否会在产后的前48小时减少累积的阿片类药物剂量.
主要方法:
- 一个基于证据的ERAS协议,包括内吗啡,已经实施了剖腹产.
- 在ERAS实施前和之后的9个月内,一个前后分析比较了口服吗啡毫克相当剂 (MME) 的使用情况.
- 以前使用过慢性阿片类药物或术后输管的患者被排除在首要结局分析之外.
主要成果:
- 在前48小时内,累计阿片类药物剂量的中位数从122个MME (ERAS前) 降至8个MME (ERAS后),降低了93.8% (P < 0.001).
- 在ERAS实施后的所有评估时间点中,阿片类药物的使用量显著下降.
- 严重疼痛得分 (> 7) 的患病率和需要任何阿片类药物的患者的百分比在ERAS后下降.
结论:
- 在剖腹产分娩后,一个包含内吗啡的ERAS协议大大降低了阿片类药物消费.
- 这种标准化的ERAS方法在产后疼痛管理和阿片类药物节约策略方面提供了显著的改进.
- 提供产科服务的医院应该考虑在剖腹产方面实施ERAS协议.
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