老年患者脊柱手术后潜在的阿片类药物相关不良事件  

Potential opioid related adverse events in elderly patients after spinal surgery

作　　者：王璨[1] 曾希银[1] WANG Can;ZENG Xi-yin(Department of Orthopaedics,the First People's Hospital of Suining,Suining,Sichuan 510370,China)

机构地区：[1]遂宁市第一人民医院骨科,四川遂宁510370

出　　处：《颈腰痛杂志》2021年第1期24-27,共4页The Journal of Cervicodynia and Lumbodynia

基　　金：宁夏回族自治区自然科学基金(编号:NZ16212)。

摘　　要：目的探讨老年患者脊柱手术后潜在的阿片类药物相关不良事件(opioid related adverse events,ORADES)及其风险因素。方法选择2010年1月~2019年10月在本院接受脊柱融合手术的352例老年患者,观察其ORADES发生率,采用单因素和多因素分析观察临床资料与ORADES的相关性。结果352例中,54例患者发生ORADES共106例次,发生率为15.34%(54/352)。单因素分析显示,ORADES组和NORADES组(非NORADES组)患者的年龄、性别、体质量指数、融合节段、吸烟、饮酒、糖尿病、慢性阻塞性肺疾病、脑卒中、认知功能降低、慢性肾脏疾病、术前心率等因素相比,差异存在统计学意义(P<0.05)。多因素Logistic分析显示,年龄≥80岁、慢性肾脏疾病是发生ORADES的风险因素(P<0.05)。结论老年脊柱融合术后存在一定的ORADES发生风险,年龄≥80岁和慢性肾脏疾病是ORADES发生的风险因素,对存在风险的患者应给予多模式镇痛方式以减少阿片类药物的应用,降低ORADES的发生率。Objective To explore the potential opioid related adverse events(ORADES)and its risk factors in elderly patients after spinal surgery.Methods From January 2010 to October 2019,352 elderly patients who underwent spinal fusion surgery in our hospital were selected as the study objects.The incidence of ORADES was observed,and the correlation between clinical data and ORADES was analyzed by single factor and multi factor analysis.Results There were 106 times of ORADES in 54 cases of 352 patients,and the incidence rate of ORADES was 15.34%(54/352).The univariate analysis showed that there were statistically significant differences in age,gender,body mass index,fusion segment,smoking,drinking,diabetes,COPD,stroke,cognitive function reduction,chronic kidney disease,preoperative heart rate between the ORADES group and NORADES group(P<0.05).The multivariate logistic analysis showed that age≥80 years old and chronic kidney disease were risk factors of ORADES(P<0.05).Conclusion There is a certain risk of ORADES after spinal fusion in the elderly.Age≥80 years old and chronic kidney disease are the risk factors of ORADES.The clinical risk factors of ORADES should be fully evaluated.Patients at high risk should be given multimodal analgesia to reduce the use of opioids and the incidence of ORADES.

关 键 词：脊柱手术 脊柱融合术 阿片类药物 舒芬太尼 不良事件 

分 类 号：R619[医药卫生—外科学]