胸部手术后增强康复:术后使用阿片类药物通过术前使用状态和新持续使用阿片类药物的危险因素
Catherine G Pratt1, Soyoung Cheon2, Jenna N Whitrock1
1Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati, Cincinnati, Ohio.
The Annals of thoracic surgery
|July 3, 2025
概括
手术后增强恢复 (ERAS) 协议减少胸部手术患者的阿片类药物使用. 然而,ERAS并没有改变在接受肺切除的先前未服用阿片类药物的患者中持续使用阿片类药物的新增率.
科学领域:
- 胸部外科手术 胸部外科手术
- 疼痛管理 疼痛管理
- 关于ERAS协议的相关内容
背景情况:
- 手术后增强恢复 (ERAS) 对胸部手术结果至关重要.
- 抗阿片类药物缓解疼痛是ERAS的一个关键组成部分,但它对先前使用阿片类药物的患者的影响需要澄清.
- 了解ERAS对新持续性阿片类药物使用 (NPOU) 的影响至关重要.
研究的目的:
- 评估ERAS协议对肺切除患者阿片类药物使用的影响.
- 确定与肺切除后新持续性阿片类药物使用 (NPOU) 相关的因素.
- 基于手术前阿片类药物暴露的ERAS影响进行比较.
主要方法:
- 利用了对肺切除患者进行前性维护的数据库.
- 将手术数据与区域处方药监测计划联系起来.
- 根据12个月的手术前阿片类药物处方史,将患者分为阿片类素素素和非阿片类素素组.
主要成果:
- 在原始和非原始组中,ERAS降低了总住院和出院的阿片类药物剂量 (吗啡毫克相当量).
- 没有服用过阿片类药物的患者经历了更短的住院时间和胸腔管持续时间与ERAS.
- 在未使用阿片类药物的患者中,ERAS的实施并没有改变10.9%的新持续阿片类药物使用率 (NPOU).
结论:
- 在肺切除患者中,ERAS协议有效地降低了整体阿片类药物消费,而不管之前的阿片类药物使用情况如何.
- 显著比例的阿片类药物未使用的患者在ERAS后出现了新的持续性阿片类药物使用 (NPOU),后术过程类似.
- 需要进一步的研究来确定NPOU风险因素,并为胸部手术患者个性化疼痛管理策略.
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