少阿片类药物镇痛对严重烧伤患者脓毒症发生率的影响:回顾性队列研究  

Effect of opioid-sparing analgesia on incidence of sepsis in severely burned patients:a retrospective cohort study

作　　者：贺秋兰[1] 莫国惠 秦莹 黄润成 刘琦 陈彩云 王钟兴[1] He Qiulan;Mo Guohui;Qin Ying;Huang Runcheng;Liu Qi;Chen Caiyun;Wang Zhongxing(Department of Anesthesiology,First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,China;Department of Anesthesiology,Zhongshan People′s Hospital,Zhongshan 528499,China;Department of Anesthesiology,Dongguan People′s Hospital,Dongguan 523058,China)

机构地区：[1]中山大学附属第一医院麻醉科,广州510080 [2]中山市人民医院麻醉科,中山528499 [3]东莞市人民医院麻醉科,东莞523058

出　　处：《中华麻醉学杂志》2023年第7期840-845,共6页Chinese Journal of Anesthesiology

基　　金：国家重点研发计划(2020YFC2008405-0)。

摘　　要：目的评价少阿片类药物镇痛对严重烧伤患者脓毒症发生率的影响。方法回顾性收集2011年至2020年广东3家烧伤中心收治的严重烧伤患者临床资料,根据伤后30 d的镇痛模式分为2组,持续阿片类药物镇痛组(连续静脉泵注阿片类药物72 h以上)和少阿片类药物镇痛组(阿片类药物PCIA/间断给予阿片类药物/无阿片类药物镇痛)。通过倾向性评分1∶1匹配患者年龄、烧伤严重度、是否合并吸入性损伤及入院静态疼痛评分。主要结局指标:入院90 d内脓毒症发生情况;次要结局指标:90 d全因死亡、30 d全因死亡情况,临床诊断的多器官功能障碍综合征(MODS)以及烧伤创面感染发生情况,并记录患者阿片类药物用量。结果最终纳入严重烧伤患者328例,持续阿片类药物镇痛组145例,少阿片类药物镇痛组183例,通过倾向性评分匹配最终纳入110对(220例)患者。与持续阿片类药物镇痛组比较,少阿片类药物镇痛组阿片类药物总用量、每镇痛日用量、每烧伤面积用量降低,脓毒症和创面感染的发生率降低(P<0.05),MODS发生率、30 d和90 d全因死亡率差异无统计学意义(P>0.05)。结论相较于持续阿片类药物镇痛,少阿片类药物镇痛可降低严重烧伤患者脓毒症的发生风险。Objective To evaluate the effects of opioid-sparing analgesia on the incidence of sepsis in severely burned patients in the retrospective cohort study.Methods The clinical data from patients with severe burns admitted to three teaching hospitals in Guangdong from 2011 to 2020 were retrospectively extracted and analyzed.The patients were divided into 2 groups based on the analgesic regimen within 30 days after injury:continuous opioids analgesia group(continuous opioid infusion at a relative constant rate for more than 72 h)and opioid-sparing analgesia group(patient-controlled intravenous analgesia/intermittent administration/opioid-free analgesia).Patient′s age,severity of burn,inhalation injury and basal pain score at rest were matched by the propensity score at a 1∶1 ratio.The primary outcome measure was the occurrence of sepsis within 90 days of admission.Secondary outcome measures included 30-day and 90-day all-cause mortality,clinical diagnosis of multiple organ dysfunction syndrome,and prevalence of burn wound infection.The amount of opioid used was also recorded.Results A total of 328 severely burned patients were finally enrolled,with 145 patients in continuous opioid analgesia group and 183 patients in opioid-sparing analgesia group,and 110 pairs of patients(220 cases)were finally matched by the propensity score.Compared with continuous opioid analgesia group,the total consumption of opioid,daily consumption per analgesia,and consumption per burn area were significantly decreased,and the incidence of sepsis and wound infection was decreased(P<0.05),and no significant change was found in the incidence of multiple organ dysfunction syndrome,30-day and 90-day all-cause mortality in opioid-sparing analgesia group(P>0.05).Conclusions Compared with the continuous opioid analgesia regimen,opioid-sparing analgesia can reduce the risk of sepsis in severely burned patients.

关 键 词：镇痛药 阿片类 烧伤 脓毒症 

分 类 号：R644[医药卫生—外科学] R459.7[医药卫生—临床医学]