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
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Impact of intrathecal morphine analgesia on the incidence of pulmonary complications after cardiac surgery: a single center propensity-matched cohort study
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1 543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。
原始文献摘要
Ellenberger C,Sologashvili T，Bhaskaran K,et al.Impact of intrathecal morphine analgesia on the incidence of pulmonary complications after cardiac surgery: a single center propensity-matched cohort study.BMC Anesthesiol.2017 Aug 22;17(1):109. doi: 10.1186/s12871-017-0398-z
Abstract
BACKGROUND:Acute pain and systemic opioids may both negatively impact respiratory function after cardiac surgery. This study analyzes the local practice of using intrathecal morphine analgesia (ITMA) with minimal parenteral opioid administration in cardiac surgery, specifically the impact on postoperative pulmonary complications (PPCs).
METHODS:Data from adult patients who underwent elective cardiac surgery between January 2002, and December 2013 in a single center were analyzed. Propensity scores estimating the likelihood of receiving ITMA were used to match (1:1) patients with ITMA and patients with intravenous analgesia (IVA). Primary outcome was PPCs, a composite endpoint including pneumonia, adult respiratory distress syndrome, and any type of acute respiratory failure. Secondary outcomes were in-hospital mortality, cardiovascular complications, and length of stay in the intensive care unit (ICU) and hospital.
RESULTS:From a total of 1'543 patients, 920 were treated with ITMA and 623 with IVA. No adverse event consequent to the spinal puncture was reported. Propensity score matching created 557 balanced pairs. The occurrence of PPCs in patients with ITMA was 8.1% vs. 12.8% in patients with IVA (odds ratio, 0.6; 95% CI, 0.40-0.89; p = 0.012). Fewer patients with ITMA had a prolonged stay in the ICU (> 4 days; 16.5% vs. 21.2%, p = 0.047) or in the hospital (> 15 days; 25.5% vs. 31.8%. p = 0.024). In-hospital mortality and cardiovascular complications did not differ significantly between the two groups.
CONCLUSION:In this study involving cardiac surgical patients, ITMA was safely applied and was associated with fewer PPCs.
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