对于非癌症疼痛而言,阿片类药物使用者之间妄的比较风险:一个回顾性队列研究
Carlos Raul Ramirez Medina1, Mark Lunt1, William G Dixon1,2,3,4
1Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, The University of Manchester, Stopford Building, Oxford Road, Manchester, M13 9PT, UK.
BMC medicine
|January 31, 2026
概括
某些阿片类药物,如氧化和芬太尼,与可代因相比,在非癌症疼痛患者中增加了医院妄风险. 这凸显了需要个性化阿片类药物处方来预防不良事件的必要性.
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
- 患者安全 患者安全
背景情况:
- 治疗慢性非癌症疼痛的阿片类药物使用在英国很普遍,尽管长期疗效数据有限.
- Delirium,一个严重的混乱状态,是已知的阿片类药物不良影响与增加的死亡率.
- 关于不同类阿片类药物如何影响妄风险的比较证据很少.
研究的目的:
- 评估阿片类型和剂量之间的关联,以及非癌症患者在医院内 Delirium 的风险.
- 为了比较慢性疼痛管理中使用的各种阿片类药物之间的妄想风险.
- 为了告知阿片类药物处方的临床决策,以减轻妄想风险.
主要方法:
- 使用来自英国第三级医疗保健医院的电子健康记录 (EHR) 的回顾性队列研究 (2014-2020).
- 包括没有癌症的成年人 (≥18岁) 接受阿片类药物治疗;通过4'A测试或ICD-10代码/混分数识别的妄想.
- 转换为每日吗啡毫克相当量的阿片类药物剂量 (MME/天);因混因素而调整的考克斯回归模型.
主要成果:
- 在50586名暴露于阿片类药物的患者中,1.7%的人患有 Delirium.
- 氧化,芬太尼,布普伦诺芬,组合阿片类药物和吗啡与与可代因相比显著更高的妄想风险有关.
- 没有观察到明确的剂量反应关系;与<50 MME/day相比,50-119 MME/day并没有显著增加风险.
结论:
- 与可代因相比,氧化,芬太尼,布普伦诺芬,吗啡和组合阿片类药物与增加住院 Delirium 风险有关.
- 氧化显示出比代因和吗啡都更高的妄想风险.
- 研究结果支持针对非癌症疼痛进行个性化阿片类药物处方,以防止妄想.
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