后路腰椎减压术后阿片类镇痛药物用量的影响因素回顾性分析

PATIENT-SPECIFIC FACTORS AFFECTING PATIENT-CONTROLLED ANALGESIA DOSING OF OPIOIDS DRUGS AFTER LUMBAR SPINE SURGERY

目的:探索后路腰椎管减压手术病人术后阿片类药物镇痛泵用药量的相关影响因素。方法:回顾性分析北京协和医院在全身麻醉下接受后路腰椎管减压手术且术后使用舒芬太尼镇痛泵的病人,根据术后第一个24 h阿片类镇痛药物用量分为低镇痛药量组(patient-controlled analgesia-low dose,PCA-L)和高镇痛药量组(patient-controlled analgesia-high dose,PCA-H),分别比较两组的一般临床资料和手术、麻醉相关资料,并对镇痛药量偏大的病人资料进行归因分析。结果:高镇痛药量组(PCA-H)病人,年龄偏小,体重偏轻,体重指数(Body Mass Index,BMI)偏低,ASA分级偏低,应用胶体液的比例偏大(P均<0.05);两组病人性别、身高、手术时间、吸入/静脉麻醉、芬太尼用量、瑞芬太尼速度、是否泵注右美托咪定、异体血输注量、自体血输注量、出血量、晶体液量无显著差异。年龄小于65岁是镇痛药量较高的独立危险因素。结论:体重、BMI、年龄、ASA分级和术中输入胶体液可能会影响后路腰椎管减压手术后阿片类镇痛药的用量,其中年龄<65岁是导致用药量偏大的独立危险因素。

Objective： This study investigated the factors affecting sufentanyl consumption of intravenous patient-controlled analgesia （IVPCA） among patients after lumber spine surgery. Methods： We conducted a retrospective analysis of 324 patients who underwent elective posterior lumbar spinal surgery in Peking Union Medical College Hospital and consented to control postoperative pain with sufentanyl IVPCA. Patients whose 24-hour postoperative sufentanyl consumption （postop-Suf） ranking in the 1st quartile were assigned to PCA-L （Patient-controlled analgesia-low dose） group, while patients with postop-Suf ranking in the 4th quartile were assigned to PCA-H （Patient-controlled analgesia-high dose） group. Demographic data, surgical procedures, an- algesia variables, were collected for comparison. Results： The patients in PCA-H group had younger age, lower weight, lower body mass index （BMI）, lower ASA classification, higher rate of colloid usage （/9 〈 0.05）. None of the sex, height, surgery duration, inhaled/intravenous agent, intraoperative fentanyl dosage, infusion speed of remifentanyl, dexmedetomidine infusion, liquid amount and type affected postop-Suf requirements. Binary Logistic regression analysis showed that age younger than 65 was the independent predictor for higher opiods consumption of IVPCA （OR = 0.472, 95% CI = 0.250-0.892）. Conclusions： The weight, BMI, age, ASA clas- sification and colloid use were significantly associated with IVPCA requirement. Age younger than 65 was the independent predictor for higher opioids consumption of IVPCA after posterior lumber spine surgery.