脊柱创伤手术后的术后阿片类药物利用:一级创伤中心的一项回顾性研究
Prashant V Rajan1, Emmanuel Dean2,3, Andrew H Milby2,4
1Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Journal of spine surgery (Hong Kong)
|October 15, 2025
概括
在脊椎创伤患者手术后的阿片类药物使用显著下降. 不完整的脊髓损伤预测了长时间的阿片类药物使用,而老年和宫损伤有助于断奶.
科学领域:
- 神经外科 神经外科
- 疼痛管理 疼痛管理
- 脊柱创伤研究 脊柱创伤研究
背景情况:
- 对影响脊柱创伤患者长期使用阿片类药物的损伤特定因素的有限理解.
- 需要确定阿片类药物使用和断奶的临床和神经学预测因素.
研究的目的:
- 在创伤性脊柱损伤手术患者中确定术后阿片类药物使用和断奶的可修改和不可修改的预测因素.
- 澄清与长期阿片类药物依赖相关的损伤特定因素.
主要方法:
- 对109名因脊柱创伤而接受手术的成年患者的回顾性图表审查 (2017年7月至2021年5月).
- 提取了人口统计,外科手术期间和损伤特征数据.
- 在出院和随访时使用双变量和多变量后勤回归分析了与吗啡毫克相当量 (MME) 的关联.
主要成果:
- 从出院到最后的随访,阿片类药物的使用减少了66.2% (89.4%到23.2%).
- 出院时的MME较高,与 incomplete脊髓损伤 (SCI) 和部分运动/感官恢复有关.
- 成功断奶的独立预测因素包括年龄较大,椎损伤和完全的SCI.
结论:
- 长期使用阿片类药物显著下降,但不完全的SCI和部分恢复增加了长期使用的风险.
- 宫损伤和年龄较大与成功的阿片类药物断奶相关.
- 这些发现支持基于损伤模式的个性化,神经学知情的疼痛管理和早期阿片类药物风险分层.
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