在心脏外科手术中加强手术后恢复 (ERAS) 协议:对阿片类药物消费的影响
Alexandra Othenin-Girard1, Zied Ltaief2, Mario Verdugo-Marchese3
1Department of Anesthesia, Lausanne University Hospital (CHUV), 1011 Lausanne, Switzerland.
Journal of clinical medicine
|March 17, 2025
概括
在心脏外科手术中实施手术后增强恢复 (ERAS) 协议显著减少了阿片类药物消耗,改善了患者的康复. 这个ERAS计划导致了更短的住院时间和更少的并发症.
科学领域:
- 心血管外科心血管外科
- 麻醉学 麻醉学
- 关键护理医学 关键护理医学
背景情况:
- 手术后增强恢复 (ERAS) 协议旨在优化手术患者的治疗结果,并减少阿片类药物的使用.
- 在心脏外科手术中,高阿片类药物消耗与延长的机械通风,延长的重症监护室 (ICU) 停留以及与阿片类药物相关的不良药物事件 (ORADEs) 有关.
- 这项研究评估了ERAS学会认证的关于在选择性心脏手术患者中使用阿片类药物的计划的有效性.
研究的目的:
- 评估ERAS协议对手术内和手术后阿片类药物消费的影响.
- 为了比较ERAS和传统护理组之间的患者康复参数,包括疼痛控制,输出管时间和停留时间.
- 在ERAS框架内确定预测减少阿片类药物使用的因素.
主要方法:
- 一个回顾性,单心的观察性研究,比较ERAS (2023-2024) 和控制 (2019) 队列.
- 从电子医疗记录和ERAS程序数据库中收集数据.
- 主要结局:总的阿片类药物消耗 (在术后和术后的0-3天). 二次结果:疼痛,ICU住院,并发症和住院时间.
主要成果:
- 在ERAS患者的手术内 (sufentanil:40mcg vs. 51mcg) 和术后阿片类药物消耗 (POD 0-3) 显著降低.
- ERAS组经历了更快的输出,更早的动员,使用非阿片类药物止痛药改善疼痛管理,减少并发症和更短的住院时间 (9 vs. 12天).
- 多变量后勤回归确定了快速排卵和没有并发症作为降低阿片类药物使用的关键预测因素.
结论:
- 在心脏外科手术中实施ERAS协议有效地减少了阿片类药物消费.
- 通过改善疼痛管理和减少并发症,ERAS协议可以促进患者的康复.
- 经过ERAS协会认证的项目对接受选择性心脏手术的患者有显著的好处.
相关概念视频
01:26Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy
38
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...
38
01:15Opioid Analgesics: Synthetic and Semisynthetic Opioids
200
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...
200
01:20Exercise and Cardiovascular Response
683
Exercise significantly impacts cardiovascular response, which is crucial for understanding patient health and designing effective treatment plans.
Light to moderate physical activity initiates a series of interconnected responses in the body. The heart rate modestly increases in anticipation of the workout, followed by widespread vasodilation as oxygen consumption by skeletal muscles increases. This results in decreased peripheral resistance, increased capillary blood flow, and accelerated...
Light to moderate physical activity initiates a series of interconnected responses in the body. The heart rate modestly increases in anticipation of the workout, followed by widespread vasodilation as oxygen consumption by skeletal muscles increases. This results in decreased peripheral resistance, increased capillary blood flow, and accelerated...
683
01:20Opioid Analgesics: Morphine and Other Natural Cogeners
151
Opioids are a class of drugs that mimic endogenous opioid peptides and act on opioid receptors, and help in pain relief. These compounds are classified as natural, synthetic, or semi-synthetic. Natural opioids, like morphine, codeine, and thebaine, are derived from the opium poppy plant (Papaver somniferum or Papaver album) and are termed opiates. Synthetic opioids are artificial, while semi-synthetic opioids combine natural and synthetic compounds. Morphine, a prototypical opioid, possesses a...
151