多种疾病和止痛药相关的危害:系统性审查
Christopher H Grant1, Heather Walker2, Karen N Barnett1
1Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK.
British journal of anaesthesia
|March 20, 2025
概括
患有多种慢性疾病的成年人使用阿片类药物会增加死亡率和过量服用的风险. 关于 gabapentinoid 危害的证据是有限的,这凸显了对安全疼痛管理策略的研究的需要.
科学领域:
- 药理学 药理学是指药理学的学科.
- 临床医学 临床医学
- 公共卫生 公共卫生
背景情况:
- 多病症,即多种慢性疾病的存在,影响着人口的很大一部分.
- 慢性疼痛在多病症患者中非常普遍,但最佳止痛策略仍然不清楚.
- 了解与常见止痛药相关的风险对于管理这种患者群体至关重要.
研究的目的:
- 系统地审查和量化与阿片类药物,非类固醇抗炎药物 (NSAID) 和加巴丁类药物在成年人多病症中使用相关的不良结果的风险.
- 确定有关多种慢性疾病患者止痛药安全性的证据缺口.
主要方法:
- 在多个数据库 (Medline,CINAHL,Web of Science,Embase,CENTRAL) 进行了全面的文献搜索.
- 报告止痛药相关危害或多病症对危害的影响的研究被两个独立研究人员选.
- 进行了数据提取和偏差风险评估 (纽卡斯尔-太华尺度),随后进行了按止痛药类分组的叙事综合.
主要成果:
- 包括27项涉及超过260万患者的研究,显示异质性和可变质量.
- 吸食阿片类药物与多种疾病的成年人死亡率增加,过量服用和死亡有关.
- 非类固醇抗炎药物 (NSAIDs) 与不良结果有关,包括评估的一半研究中的胃肠道出血.
- 关于 gabapentinoids 的有限数据表明与狂妄症和肺炎的关联,但没有死亡率.
结论:
- 在成年人中,阿片类药物具有显著的危害,包括过量服用和死亡率增加.
- 在这个人群中,关于 gabapentinoids 的安全性和有效性的证据严重缺乏.
- 进一步的研究是必不可少的,以建立最佳和安全的止痛药管理指南,为个人与多病症.
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