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早期阿片类药物使用与极度早产婴儿的结果之间的关联:全国性的研究
Hiroki Kitaoka1,2, Takaaki Konishi3, Yoshihiko Shitara4
1Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan. kitaokahir@m.u-tokyo.ac.jp.
Pediatric research
|March 18, 2025
概括
在极度早产的婴儿中,早期使用阿片类药物并没有增加死亡率或心室内出血. 虽然周周结膜性白血病减少,但观察到更长的住院时间和增加的支气管肺功能障碍.
科学领域:
- 新生儿科学 新生儿科学
- 药理学 药理学是指药理学的学科.
- 儿科重症监护中心儿童重症监护中心
背景情况:
- 阿片类药物经常用于极度早产婴儿,以预防诸如心室内出血等严重疾病.
- 早期阿片类药物给药对婴儿结局的短期影响尚不清楚.
- 这项研究调查了早期阿片类药物使用与这种脆弱人群的住院结果之间的关联.
研究的目的:
- 评估早期阿片类药物给药与极度早产婴儿的住院结果之间的关联.
- 为了确定早期阿片类药物使用是否影响死亡率,主要发病率或医疗保健资源利用率.
- 为临床决策提供关于新生儿重症监护中的阿片类药物使用的证据.
主要方法:
- 一个回顾性的全国性队列研究,利用日本的诊断程序组合数据库.
- 包括2010年7月至2021年3月期间住院的18794名极度早产婴儿.
- 1:2的倾向分数匹配分析比较了早期接受阿片类药物的婴儿 (n=4806) 与没有接受阿片类药物的婴儿 (n=13,988).
主要成果:
- 在匹配后,阿片类药物暴露和非暴露组之间的住院死亡率和腹腔内出血率相似.
- 在接受早期阿片类药物治疗的婴儿中,观察到周周结膜白血病的统计显著下降 (1.7%与2.2%相比).
- 然而,早期的阿片类药物使用与支气管肺功能失调的增加率 (65%与58%),更高的家庭辅助技术使用率 (19%与15%) 和更长的住院时间 (125与122天) 相关.
结论:
- 在极度早产婴儿的早期阿片类药物管理与增加的住院死亡率或心室内出血无关.
- 在早期使用阿片类药物时,观察到周周结膜白血病的轻微减少.
- 尽管有这些好处,但临床医生应考虑与早期阿片类药物暴露相关的支气管肺功能失调和长时间住院的风险增加.
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