作为个性化的术后疼痛管理来调整术后阿片类药物剂量的决策支持工具:系统性审查
Pernille Bjersand Sunde1, Ida Houtved Rasmussen1,2, Caroline Folkersen1,2
1Department of Anaesthesia and Intensive Care, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark.
Acta anaesthesiologica Scandinavica
|November 11, 2025
概括
用于个性化术后阿片类药物剂量的决策支持工具没有明显的临床效用. 目前的方法无法改善疼痛管理或减少手术患者的阿片类药物相关不良事件.
科学领域:
- 疼痛管理 疼痛管理
- 麻醉学 麻醉学
- 外科手术的结果
背景情况:
- 高达60%的手术患者经历中度至重度的疼痛和与阿片类药物相关的不良反应.
- 目前的疼痛管理指南依赖于标准化剂量,而不是个体患者的需求.
- 需要量身定制的阿片类药物治疗来优化患者的治疗结果.
研究的目的:
- 确定和评估用于调整外科手术期间系统性阿片类药物剂量的决策支持工具.
- 评估这些工具对个性化术后疼痛管理的影响.
- 确定这些工具在改善患者治疗结果方面的有效性.
主要方法:
- 对预测模型和感觉监测系统的研究进行系统审查.
- 在EMBASE,MEDLINE和Cochrane图书馆搜索到2025年8月.
- 评估了偏差风险,并对干预研究 (仅RCT) 进行了元分析.
主要成果:
- 包括19项关于决策支持工具 (预测模型和感觉监测系统) 的研究.
- 预测模型显示偏差风险高,验证有限,性能差.
- 感觉监测系统没有显著改善疼痛,阿片类药物使用或不良事件.
结论:
- 没有经过测试的预测模型为个性化阿片类药物治疗提供了指导.
- 导向的阿片类药物剂量并没有改善急性术后结果.
- 目前的决策支持工具缺乏用于优化阿片类药物剂量的临床实用性.
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