评估紧急一般手术患者的阿片类药物处方变化
Patrick L Johnson1, Jamila K Picart1, Anne H Cain-Nielsen2
1Department of Surgery, University of Michigan Medical School, Ann Arbor, MI; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI.
Surgery
|September 5, 2025
概括
紧急手术的阿片类药物处方在各医院之间存在很大差异,并且经常与选择性手术的指导方针相悖. 伴随性疾病等患者因素影响这些处方模式,强调需要改善阿片类药物管理.
科学领域:
- 外科手术
- 药理学
- 医疗服务研究
背景情况:
- 在选择性手术中对术后的阿片类药物处方有确定的指导方针.
- 在紧急一般手术环境中遵守这些指导方针尚不清楚.
- 紧急阿片类药物处方的变化可能表明偏离最佳实践或必要的调整.
研究的目的:
- 评估应急整体手术的选择性阿片类药物处方指南的遵守情况.
- 评估不同机构处方阿片类药物的差异.
- 确定与非指导方针一致的阿片类药物处方相关的患者级因素.
主要方法:
- 分析来自全州急症手术协会的数据.
- 包括经过腹腔镜尾切除,胆囊切除,紧急修复和开放式切除的患者.
- 使用风险和可靠性调整的多层模型来评估处方大小和指南的遵守.
主要成果:
- 处方阿片类药物的实验室水平显著变化 (吗啡类药物的1.5 - 3. 7倍,无阿片类药物的1. 1 - 2.3倍).
- 与尾切除术 (4%) 相比,大肠切除术的处方不太可能符合指导方针 (25%).
- 与非指导方针一致的处方与增加的并发症负担和更高的ASA身体状况有关.
结论:
- 在紧急一般手术中,阿片类药物的处方模式显示出相当大的变化.
- 处方经常与选修程序的既定指导方针不一致.
- 在紧急情况下需要考虑程序和患者特定的因素来优化阿片类药物管理.
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