术前长期阿片或糖皮质激素的使用和非心脏手术后死亡率的关系：回顾性队列研究

2021-02-03 米勒之声

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中文摘要

术前长期阿片或糖皮质激素的使用和非心脏手术后死亡率的关系：回顾性队列研究

贵州医科大学高鸿教授课题组

翻译：牛振瑛编辑：佟睿审校：曹莹

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背景

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长期使用阿片类药物和糖皮质激素会带来严重的副作用。此外，两种药物均与长期术后不良结局有关。

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目的

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该研究旨在调查术前长期阿片类药物和糖皮质激素的使用与非心脏手术后90天死亡率之间的关系。

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设计

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回顾性，基于人群的队列研究。

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地点设置

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三级教学医院。

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研究对象

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该研究招募了2012年1月至2018年12月间在首尔国立大学盆唐医院住院的成年（18岁）患者，这些患者进行择期的非心脏手术。

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主要观察指标

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该研究比较了术前长期使用阿片类药物或糖皮质激素的患者（≥3个月）与非阿片类药物和糖皮质激素使用的患者的90天死亡率的差异。

结果：该研究总共包括112606名患者。其中，无阿片类药物和无糖皮质类药物的患者为107 843（95.9％）；长期使用阿片类药物和/或糖皮质激素的患者分别为3373名（3.0％），1199名（1.1％）和191名患者（0.2％）。在多变量模型中，与无阿片类药物和糖皮质激素使用的患者相比，长期使用阿片类药物[3.56倍；95％置信区间（CI）2.36至5.38; P ＜0.001]，糖皮质激素（4.17倍；95％CI 3.28至5.29；P ＜0.001）以及阿片和糖皮质激素联合应用（7.66倍；95％CI 3.91至15.01；P ＜0.001）的患者在90天内死亡的几率显着增高。

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结论

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与无阿片类和无阿片类药物的患者相比，术前联合或单独使用阿片类药物和糖皮质激素类药物的患者90天死亡率增加。我们的结果表明，应对长期使用阿片类药物和糖皮质激素的患者谨慎管理。

Pre-operative chronic opioid or glucocorticoid use and mortality after noncardiac surgery：A retrospective cohort study

Abstract

BACKGROUND The chronic use of opioids and glucocorticoids is associated with serious side effects. Moreover, both medications are related to poor long-term postoperative outcomes.

OBJECTIVE The study aimed to investigate the association between pre-operative chronic opioid and glucocorticoid use and 90-day mortality after noncardiac surgery.

DESIGN Retrospective, population-based cohort study.

SETTING Single tertiary academic hospital.

PATIENTS The study enrolled adult (≥18 years of age) patients admitted to Seoul National University Bundang Hospital, between January 2012 and December 2018 for planned, elective, noncardiac surgery.

MAIN OUTCOME MEASURES The study compared the 90-day mortality for patients using opioids or glucocorticoids chronically (≥3 months) prior to surgery and for opioid-naı ¨ve and glucocorticoid-naı ¨ve patients.

RESULTS A total of 112 606 patients were included in the study. Among them, 107 843 (95.9%) were opioid-naı ¨ve and glucocorticoid-naı ¨ve patients; 3373 (3.0%), 1199 (1.1%) and 191 patients (0.2%) were chronic users of opioids,glucocorticoids or both, respectively. In the multivariable model, compared with opioid-naı ¨ve and glucocorticoid-naı ¨ve patients, the odds of dying within 90 days were significantly higher for chronic users of opioids [3.56-fold; 95% confidence intervals (CIs) 2.36 to 5.38; P<0.001], glucocorticoids (4.17-fold; 95% CI 3.28 to 5.29; P<0.001) and combined opioids and glucocorticoids (7.66-fold; 95% CI 3.91 to 15.01; P<0.001).

CONCLUSION Chronic pre-operative use of opioids and glucocorticoids, together or individually, were associated with increased 90-day mortalities after noncardiac surgery, compared with opioid-naı ¨ve and glucocorticoid-naı ¨ve patients. Our results suggest that chronic pre-operative use of opioids and glucocorticoids should be managed carefully.