静脉阿片类药物剂量对术后肠梗阻的影响。

Influence of intravenous opioid dose on postoperative ileus.

机构信息

Department of Pharmacy Practice, College of Pharmacy, Midwestern University, Glendale, AZ, USA.

出版信息

Ann Pharmacother. 2011 Jul;45(7-8):916-23. doi: 10.1345/aph.1Q041. Epub 2011 Jul 5.

DOI:10.1345/aph.1Q041

PMID:21730280

Abstract

BACKGROUND

Intravenous opioids represent a major component in the pathophysiology of postoperative ileus (POI). However, the most appropriate measure and threshold to quantify the association between opioid dose (eg, average daily, cumulative, maximum daily) and POI remains unknown.

OBJECTIVE

To evaluate the relationship between opioid dose, POI, and length of stay (LOS) and identify the opioid measure that was most strongly associated with POI.

METHODS

Consecutive patients admitted to a community teaching hospital who underwent elective colorectal surgery by any technique with an enhanced-recovery protocol postoperatively were retrospectively identified. Patients were excluded if they received epidural analgesia, developed a major intraabdominal complication or medical complication, or had a prolonged workup prior to surgery. Intravenous opioid doses were quantified and converted to hydromorphone equivalents. Classification and regression tree (CART) analysis was used to determine the dosing threshold for the opioid measure most associated with POI and define high versus low use of opioids. Risk factors for POI and prolonged LOS were determined through multivariate analysis.

RESULTS

The incidence of POI in 279 patients was 8.6%. CART analysis identified a maximum daily intravenous hydromorphone dose of 2 mg or more as the opioid measure most associated with POI. Multivariate analysis revealed maximum daily hydromorphone dose of 2 mg or more (p = 0.034), open surgical technique (p = 0.045), and days of intravenous narcotic therapy (p = 0.003) as significant risk factors for POI. Variables associated with increased LOS were POI (p < 0.001), maximum daily hydromorphone dose of 2 mg or more (p < 0.001), and age (p = 0.005); laparoscopy (p < 0.001) was associated with a decreased LOS.

CONCLUSIONS

Intravenous opioid therapy is significantly associated with POI and prolonged LOS, particularly when the maximum hydromorphone dose per day exceeds 2 mg. Clinicians should consider alternative, nonopioid-based pain management options when this occurs.

摘要

背景

静脉内阿片类药物是术后肠梗阻（POI）病理生理学的主要组成部分。然而，最适当的措施和阈值来量化阿片类药物剂量（例如，平均日，累积，最大日）与 POI 之间的关联仍然未知。

目的

评估阿片类药物剂量，POI 和住院时间（LOS）之间的关系，并确定与 POI 最密切相关的阿片类药物测量指标。

方法

回顾性确定了在社区教学医院接受任何技术行择期结肠直肠手术并接受术后强化康复方案的连续患者。如果患者接受硬膜外镇痛，发生重大腹腔内并发症或医疗并发症，或在手术前进行了长时间的检查，则将其排除在外。量化静脉内阿片类药物剂量并转换为氢吗啡酮当量。使用分类回归树（CART）分析确定与 POI 最相关的阿片类药物测量指标的剂量阈值，并定义高或低阿片类药物使用。通过多变量分析确定 POI 和延长 LOS 的危险因素。

结果

在 279 例患者中，POI 的发生率为 8.6％。CART 分析确定最大日静脉氢吗啡酮剂量为 2 毫克或更高为与 POI 最相关的阿片类药物测量指标。多变量分析显示，最大日氢吗啡酮剂量为 2 毫克或更高（p = 0.034），开放式手术技术（p = 0.045）和静脉内麻醉治疗天数（p = 0.003）是 POI 的重要危险因素。与 LOS 增加相关的变量是 POI（p <0.001），最大日氢吗啡酮剂量为 2 毫克或更高（p <0.001）和年龄（p = 0.005）; 腹腔镜检查（p <0.001）与 LOS 减少相关。