BMC Anesthesiol:鞘内注射吗啡镇痛对心脏手术后肺部并发症发生率的影响:单中心倾向匹配队列研究

2017-11-17 佘玉琦 “罂粟花”微信号

急性疼痛和阿片类药物可能对心脏手术后的呼吸功能产生负面影响。本研究分析了在心脏手术中鞘内给予吗啡镇痛与静脉给予阿片物质镇痛对术后肺部并发症的影响。

背景与目的:急性疼痛和阿片类药物可能对心脏手术后的呼吸功能产生负面影响。本研究分析了在心脏手术中鞘内给予吗啡镇痛与静脉给予阿片物质镇痛对术后肺部并发症的影响。

方  法:对2002年1月至2013年12月在单一中心接受择期心脏手术的成年患者进行了数据分析。使用倾向评分估计了接受吗啡镇痛的可能性,吗啡镇痛的患者和静脉镇痛的患者以1:1匹配。主要结局是肺部并发症,复合终点包括肺炎,成人呼吸窘迫综合征和任何类型的急性呼吸衰竭。次要结局是住院死亡率,心血管并发症以及重症监护病房和医院的停留时间。

结  果:共有1543例患者,920例接受吗啡镇痛治疗,623例接受静脉给予阿片物质镇痛治疗。脊柱穿刺引起的不良事件未见报告。倾向评分匹配了557个平衡对。肺部并发症发生率显示吗啡镇痛为8.1% VS.阿片物质镇痛为12.8%(优势比为0.6; 95%CI为0.40-0.89; p = 0.012)。鞘内给予吗啡镇痛的患者在ICU(> 4days; 16.5% vs. 21.2%, p=0.047)或医院的停留时间较短(> 15days; 25.5% vs. 31.8%. p=0.024)。住院死亡率和心血管并发症组间差异无统计学意义。

结  论:在涉及心脏手术患者的这项研究中,鞘内给予吗啡镇痛得到安全应用,与肺部并发症较低相关联。

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    2018-07-05 丁鹏鹏
  4. 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createdAvatar=https://thirdqq.qlogo.cn/qqapp/101173734/363C99735735B7F4CB11D5F78F580525/100, createdBy=aab22500211, createdName=ms3025846204744509, createdTime=Fri Aug 24 14:37:00 CST 2018, time=2018-08-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1757896, encodeId=b66b1e578968e, content=<a href='/topic/show?id=84ba49031f9' target=_blank style='color:#2F92EE;'>#并发#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=49031, encryptionId=84ba49031f9, topicName=并发)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a27e37327108, createdName=丁鹏鹏, createdTime=Thu Jul 05 03:37:00 CST 2018, time=2018-07-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2050942, encodeId=660020509422b, content=<a href='/topic/show?id=95f8e042dd' target=_blank style='color:#2F92EE;'>#EST#</a>, beContent=null, objectType=article, 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href='/topic/show?id=256a96e9990' target=_blank style='color:#2F92EE;'>#镇痛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=96799, encryptionId=256a96e9990, topicName=镇痛)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Sun Nov 19 03:37:00 CST 2017, time=2017-11-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1545229, encodeId=4ae615452297c, content=<a href='/topic/show?id=93c682342bb' target=_blank style='color:#2F92EE;'>#肺部并发症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82342, encryptionId=93c682342bb, topicName=肺部并发症)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7a8513702341, createdName=644982816_68283325, createdTime=Sun Nov 19 03:37:00 CST 2017, time=2017-11-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1588280, encodeId=69ed158828059, content=<a href='/topic/show?id=1cb8e014e0' target=_blank style='color:#2F92EE;'>#ESI#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7014, encryptionId=1cb8e014e0, topicName=ESI)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f4f817593223, createdName=skhzy, createdTime=Sun Nov 19 03:37:00 CST 2017, time=2017-11-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1615714, encodeId=d8b41615e142c, content=<a href='/topic/show?id=c75c9998e5d' target=_blank style='color:#2F92EE;'>#鞘内注射#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99987, encryptionId=c75c9998e5d, topicName=鞘内注射)], attachment=null, 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  5. [GetPortalCommentsPageByObjectIdResponse(id=1826399, encodeId=038c18263990a, content=<a href='/topic/show?id=e5283e89970' target=_blank style='color:#2F92EE;'>#发生率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37899, encryptionId=e5283e89970, topicName=发生率)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30bd35, createdName=一叶知秋, createdTime=Thu Dec 21 04:37:00 CST 2017, time=2017-12-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1974778, encodeId=33b219e47787c, content=<a href='/topic/show?id=f145355379' target=_blank style='color:#2F92EE;'>#BMC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3553, encryptionId=f145355379, topicName=BMC)], attachment=null, authenticateStatus=null, 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href='/topic/show?id=256a96e9990' target=_blank style='color:#2F92EE;'>#镇痛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=96799, encryptionId=256a96e9990, topicName=镇痛)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Sun Nov 19 03:37:00 CST 2017, time=2017-11-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1545229, encodeId=4ae615452297c, content=<a href='/topic/show?id=93c682342bb' target=_blank style='color:#2F92EE;'>#肺部并发症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82342, encryptionId=93c682342bb, topicName=肺部并发症)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7a8513702341, createdName=644982816_68283325, createdTime=Sun Nov 19 03:37:00 CST 2017, time=2017-11-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1588280, encodeId=69ed158828059, content=<a href='/topic/show?id=1cb8e014e0' target=_blank style='color:#2F92EE;'>#ESI#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7014, encryptionId=1cb8e014e0, topicName=ESI)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f4f817593223, createdName=skhzy, createdTime=Sun Nov 19 03:37:00 CST 2017, time=2017-11-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1615714, encodeId=d8b41615e142c, content=<a href='/topic/show?id=c75c9998e5d' target=_blank style='color:#2F92EE;'>#鞘内注射#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99987, encryptionId=c75c9998e5d, topicName=鞘内注射)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c3bb19663119, createdName=zywlvao, createdTime=Sun Nov 19 03:37:00 CST 2017, time=2017-11-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=262029, encodeId=c8f726202931, content=学习了.谢谢., beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/xkvRjYnJzzRJ2R0y7VhicibvkjPWHjIMmu4ZpKnE9cWAu4lVicS3uDUCfF4M4JWvrkrYfpb2KehPV0Ee29tPqyPEebBUibiaKhnvD/0, createdBy=f8412001184, createdName=惠映实验室, createdTime=Fri Nov 17 13:26:43 CST 2017, time=2017-11-17, status=1, ipAttribution=)]
    2017-11-19 showtest
  6. [GetPortalCommentsPageByObjectIdResponse(id=1826399, encodeId=038c18263990a, content=<a href='/topic/show?id=e5283e89970' target=_blank style='color:#2F92EE;'>#发生率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37899, encryptionId=e5283e89970, topicName=发生率)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30bd35, createdName=一叶知秋, createdTime=Thu Dec 21 04:37:00 CST 2017, time=2017-12-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1974778, encodeId=33b219e47787c, content=<a href='/topic/show?id=f145355379' target=_blank style='color:#2F92EE;'>#BMC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3553, encryptionId=f145355379, topicName=BMC)], attachment=null, authenticateStatus=null, 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time=2017-11-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1588280, encodeId=69ed158828059, content=<a href='/topic/show?id=1cb8e014e0' target=_blank style='color:#2F92EE;'>#ESI#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7014, encryptionId=1cb8e014e0, topicName=ESI)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f4f817593223, createdName=skhzy, createdTime=Sun Nov 19 03:37:00 CST 2017, time=2017-11-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1615714, encodeId=d8b41615e142c, content=<a href='/topic/show?id=c75c9998e5d' target=_blank style='color:#2F92EE;'>#鞘内注射#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99987, encryptionId=c75c9998e5d, topicName=鞘内注射)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c3bb19663119, createdName=zywlvao, createdTime=Sun Nov 19 03:37:00 CST 2017, time=2017-11-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=262029, encodeId=c8f726202931, content=学习了.谢谢., beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/xkvRjYnJzzRJ2R0y7VhicibvkjPWHjIMmu4ZpKnE9cWAu4lVicS3uDUCfF4M4JWvrkrYfpb2KehPV0Ee29tPqyPEebBUibiaKhnvD/0, createdBy=f8412001184, createdName=惠映实验室, createdTime=Fri Nov 17 13:26:43 CST 2017, time=2017-11-17, status=1, ipAttribution=)]
    2017-11-19 zhaojie88
  7. 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href='/topic/show?id=256a96e9990' target=_blank style='color:#2F92EE;'>#镇痛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=96799, encryptionId=256a96e9990, topicName=镇痛)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Sun Nov 19 03:37:00 CST 2017, time=2017-11-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1545229, encodeId=4ae615452297c, content=<a href='/topic/show?id=93c682342bb' target=_blank style='color:#2F92EE;'>#肺部并发症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82342, encryptionId=93c682342bb, topicName=肺部并发症)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7a8513702341, createdName=644982816_68283325, createdTime=Sun Nov 19 03:37:00 CST 2017, time=2017-11-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1588280, encodeId=69ed158828059, content=<a href='/topic/show?id=1cb8e014e0' target=_blank style='color:#2F92EE;'>#ESI#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7014, encryptionId=1cb8e014e0, topicName=ESI)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f4f817593223, createdName=skhzy, createdTime=Sun Nov 19 03:37:00 CST 2017, time=2017-11-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1615714, encodeId=d8b41615e142c, content=<a href='/topic/show?id=c75c9998e5d' target=_blank style='color:#2F92EE;'>#鞘内注射#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99987, encryptionId=c75c9998e5d, topicName=鞘内注射)], attachment=null, 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  8. 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time=2017-11-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1588280, encodeId=69ed158828059, content=<a href='/topic/show?id=1cb8e014e0' target=_blank style='color:#2F92EE;'>#ESI#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7014, encryptionId=1cb8e014e0, topicName=ESI)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f4f817593223, createdName=skhzy, createdTime=Sun Nov 19 03:37:00 CST 2017, time=2017-11-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1615714, encodeId=d8b41615e142c, content=<a href='/topic/show?id=c75c9998e5d' target=_blank style='color:#2F92EE;'>#鞘内注射#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99987, encryptionId=c75c9998e5d, topicName=鞘内注射)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c3bb19663119, createdName=zywlvao, createdTime=Sun Nov 19 03:37:00 CST 2017, time=2017-11-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=262029, encodeId=c8f726202931, content=学习了.谢谢., beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/xkvRjYnJzzRJ2R0y7VhicibvkjPWHjIMmu4ZpKnE9cWAu4lVicS3uDUCfF4M4JWvrkrYfpb2KehPV0Ee29tPqyPEebBUibiaKhnvD/0, createdBy=f8412001184, createdName=惠映实验室, createdTime=Fri Nov 17 13:26:43 CST 2017, time=2017-11-17, status=1, ipAttribution=)]
    2017-11-19 skhzy
  9. 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  10. 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authenticateStatus=null, createdAvatar=null, createdBy=c3bb19663119, createdName=zywlvao, createdTime=Sun Nov 19 03:37:00 CST 2017, time=2017-11-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=262029, encodeId=c8f726202931, content=学习了.谢谢., beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/xkvRjYnJzzRJ2R0y7VhicibvkjPWHjIMmu4ZpKnE9cWAu4lVicS3uDUCfF4M4JWvrkrYfpb2KehPV0Ee29tPqyPEebBUibiaKhnvD/0, createdBy=f8412001184, createdName=惠映实验室, createdTime=Fri Nov 17 13:26:43 CST 2017, time=2017-11-17, status=1, ipAttribution=)]
    2017-11-17 惠映实验室

    学习了.谢谢.

    0