肺切除患者术后住院期间阿片类药物应用情况及其影响因素的回顾性队列研究

Use of opioid analgesics during postoperative hospitalization in patients undergoing lung resection and its influencing factors:A retrospective cohort study

目的调查肺切除患者术后住院期间阿片类镇痛药的使用情况及其影响因素。方法回顾性分析2017年11月—2020年1月一个多中心症状研究数据库(CN-PRO-Lung 1)中四川省肿瘤医院450例肺切除患者的临床资料,其中男248例、女202例,平均年龄(54.7±10.3)岁。结果共有448例(99.6%)使用了阿片类镇痛药。患者术后住院期间平均每天使用吗啡等效剂量为48.9 mg。分组比较显示术后吗啡使用剂量在不同性别、年龄、受教育最高程度、查尔森合并症评分、手术入路、手术方式、手术时间、术后住院时间和术后并发症级别的患者中差异具有统计学意义(P均<0.05)。多因素分析显示:性别、手术入路、术后住院时间为肺切除患者术后住院期间吗啡使用剂量的独立影响因素(P均<0.05)。结论临床上需重视男性患者的术后疼痛,并推广微创手术和尽量缩短术后住院时间,以减少阿片类药物的使用。

Objective To investigate the use of opioid analgesics during the postoperative hospitalization in patients undergoing lung resection and analyse its influencing factors.Methods The clinical data of 450 patients undergoing lung resection in Sichuan Cancer Hospital among a multicenter symptom research database(CN-PRO-Lung1)between November 2017 and January 2020 were analyzed.There were 248 males and 202 females with an average age of54.7±10.3 years.Results A total of 448(99.6%)patients used opioid analgesics.The average daily morphine equivalent dose during the postoperative hospitalization was 48.9 mg.There were statistical differences in postoperative morphine equivalent dose across patients with different sex,age,highest level of education,Charlson Comorbidity Index score,surgical approach,surgical type,operative time,postoperative hospital stay and grade of postoperative complications(all P<0.05).Multivariate analysis showed that sex,surgical approach and postoperative hospital stay were independent influencing factors for morphine use during the postoperative hospitalization in patients undergoing lung resection(all P<0.05).Conclusion In clinical practice,attention should be paid to postoperative pain for male patients,as well as to promote the application of minimally invasive surgery,and to shorten the length of postoperative hospital stay,in order to ultimately reduce the use of opioids.