国际麻醉学与复苏杂志   2021, Issue (5): 0-0
    
青少年特发性脊柱侧凸术后使用补救性阿片类药物危险因素分析
孙晶晶, 宋建申, 刘玥, 许碧云, 马正良1()
1.南京鼓楼医院
Analysis of the risk factors associated with rescue opioids after posterior spinal fusion surgery for adolescent idiopathic scoliosis
 全文:
摘要：

目的 分析青少年特发性脊柱侧凸患者行后入路脊柱矫形融合手术术后住院期间使用补救性阿片类药物的危险因素。 方法 回顾性分析2015年11月至2019年10月于南京大学医学院附属鼓楼医院首次行后入路脊柱矫形融合手术的10~18岁青少年特发性脊柱侧凸患者共877例资料。收集患者术前一般临床资料、手术麻醉相关资料、实验室检查、术后用药、术后血流动力学和并发症等，根据术后是否使用补救性阿片类药物分为使用补救性阿片类药物组（O组，182例）和未使用补救性阿片类药物组（NO组，695例），进行单因素分析和多元Logistic回归分析以筛选出术后使用补救性阿片类药物的危险因素。 结果 877例患者中有182例（20.8%）患者术后使用补救性阿片类镇痛药。两组患者年龄、手术时间、融合节段数、术后住院时间、术后引流量、术后恶心呕吐（postoperative nausea and vomiting, PONV）发生率、使用补救性非甾体类抗炎药（non‑steroidal anti‑inflammatory drugs, NSAIDs）或对乙酰氨基酚情况、术后C反应蛋白水平比较，差异有统计学意义（P<0.05）。多因素Logistic回归分析结果显示，年龄≥15岁［与<15岁比较，校正后比值比（adjusted odds ratio, aOR）=1.590，P=0.011］、术后24 h最高血压与基础血压的比值（SBPmax/bas）≥110%（与术后24 h SBPmax/bas<110%比较，aOR=1.687，P=0.007）、术后Hb较术前下降值（ΔHb）≥29 g/L（与ΔHb<29 g/L比较，aOR=1.477，P=0.028）、引流量≥13.1 ml/kg（与引流量<13.1 ml/kg比较，aOR=1.717，P=0.012）和术后补救性口服NSAIDs或对乙酰氨基酚（aOR=2.824，P<0.001）是术后使用补救性阿片类药物的危险因素。 结论 青少年特发性脊柱侧凸患者术后使用补救性阿片类药物的发生率为20.8%，年龄≥15岁、术后24 h SBPmax/bas≥110%、ΔHb≥29 g/L、引流量≥13.1 ml/kg和术后补救性口服NSAIDs或对乙酰氨基酚是术后使用补救性阿片类药物的危险因素。
关键词： 镇痛药，阿片类； 脊柱侧凸； 脊柱融合术； 患者自控静脉镇痛
Abstract:

Objective To explore the risk factors of rescue opioids after posterior spinal fusion surgery for adolescent idiopathic scoliosis. Methods A total of 877 patients with adolescent idiopathic scoliosis, aged 10‒18 years, who were scheduled for first posterior spinal fusion surgery in Nanjing Drum Tower Hospital from November 2015 to October 2019 were enrolled. Their data were retrospectively analyzed, including general clinical data before surgery, anesthesia‑related data, laboratory tests, postoperative medication, postoperative hemodynamics and complications. According to the use of rescue opioids, they were divided into two groups: a rescue opioid group (group O, n=182) and a non‑rescue opioid group (group NO, n=695). Then, univariate analysis and multivariate logistic regression were performed to screen out the risk factors associated with postoperative use of rescue opioids. Results Rescue opioids were used by 182 (20.8%) patients among 877 patients. There were statistical differences between the two groups in age, operation time, the number of fused fragments, the length of hospitalization stay, the volume of postoperative drainage, the incidence of postoperative nausea and vomiting (PONV), the use of non‑steroidal anti‑inflammatory drugs (NSAIDs) or acetaminophen for rescue analgesia, and postoperative C‑reactive protein levels (P<0.05). Multivariate logistic regression showed that age≥15 years [compared with age<15 years, adjusted odds ratio (aOR)=1.590, P=0.011], the ratio of the highest blood pressure to baseline blood pressure within 24 h after surgery (SBPmax/bas)≥ 110% (compared with SBPmax/bas within 24 h after surgery<110%, aOR=1.687, P=0.007), the decreases in Hb before and after surgery (ΔHb)≥29 g/L (compared with ΔHb<29 g/L, aOR=1.477, P=0.028), drainage volume≥13.1 ml/kg (compared with drainage volume<13.1 ml/kg, aOR=1.717, P=0.012) and the use of oral NSAIDs or acetaminophen for rescue analgesia (aOR=2.824, P<0.001) were the risk factors of postoperative rescue opioids. Conclusions The percentage of rescue opioid analgesia after posterior spinal fusion surgery for adolescent idiopathic scoliosis is 20.8%. Age≥15 years, SBPmax/bas within 24 h after surgery ≥ 110%, ΔHb≥29 g/L, drainage volume≥13.1 ml/kg and oral use of NSAIDs or acetaminophen for rescue analgesia are the risk factors of rescue opioids.
Key words: Analgesia, Opioids; Scoliosis; Spinal fusion; Patient‐controlled intravenous analgesia