Bailie George R, Mason Nancy A, Bragg-Gresham Jennifer L, Gillespie Brenda W, Young Eric W
Albany College of Pharmacy, Albany, New York 12208, USA.
Kidney Int. 2004 Jun;65(6):2419-25. doi: 10.1111/j.1523-1755.2004.00658.x.
Dialysis patients require special consideration regarding analgesics, given their altered pharmacokinetic and pharmacodynamic profiles and increased potential for adverse reactions.
Analgesic prescription patterns were investigated using data from the Dialysis Outcomes and Practice Patterns Study (DOPPS), with 3749 patients in 142 United States facilities studied between May 1996 and September 2001.
The proportion of patients prescribed any analgesic decreased from 30.2% to 24.3%; narcotic prescriptions decreased from 18.0% to 14.9%. The most commonly prescribed narcotics were propoxyphene/acetaminophen combinations (47.2%). Combinations containing acetaminophen were prescribed concurrently for 84.1% of patients on narcotics. About one half of prescriptions for narcotics, acetaminophen, and cyclooxygenase-2 (COX-2) agents were for 12 months or more; one half of prescriptions for nonsteroidal anti-inflammatory drugs (NSAIDs) were for 8 months or more. The proportion of patients prescribed analgesics varied by facility (mean +/- SD = 27.9%+/- 18.9% for all analgesics, range 0% to 89.3%). Analgesic prescription was more likely among the elderly, women, and patients with cardiovascular disease (other than coronary artery disease or congestive heart failure), lung and psychiatric disease, cancer (other than skin), and recurrent cellulitis. Patients prescribed laxatives were almost twice as likely to be on a narcotic (odds ratio = 1.95, P < 0.0001). Analgesic prescription did not correlate with loss of residual renal function or hospitalization for a gastrointestinal disorder. Three-quarters of patients reporting moderate to very severe pain were not prescribed analgesics. Furthermore, 74% of patients with pain that interfered with work had no analgesic prescription.
Dialysis patients and providers may benefit from both refinement of existing guidelines and a renewed understanding regarding appropriate prescription of analgesics.
透析患者因其药代动力学和药效学特征改变以及不良反应发生可能性增加，在使用镇痛药时需要特殊考虑。
利用来自透析结局和实践模式研究（DOPPS）的数据对镇痛药处方模式进行调查，研究对象为1996年5月至2001年9月期间美国142家机构的3749例患者。
开具任何镇痛药的患者比例从30.2%降至24.3%；麻醉性镇痛药处方从18.0%降至14.9%。最常开具的麻醉性镇痛药是丙氧芬/对乙酰氨基酚组合（47.2%）。84.1%使用麻醉性镇痛药的患者同时开具了含对乙酰氨基酚的组合药物。约一半的麻醉性镇痛药、对乙酰氨基酚和环氧化酶-2（COX-2）制剂处方时长为12个月或更长；一半的非甾体抗炎药（NSAIDs）处方时长为8个月或更长。开具镇痛药的患者比例因机构而异（所有镇痛药的均值±标准差=27.9%±18.9%，范围为0%至89.3%）。老年人、女性以及患有心血管疾病（冠状动脉疾病或充血性心力衰竭除外）、肺部疾病、精神疾病、癌症（皮肤癌除外）和复发性蜂窝织炎的患者更有可能开具镇痛药。开具泻药的患者使用麻醉性镇痛药的可能性几乎是其两倍（比值比=1.95，P<0.0001）。镇痛药处方与残余肾功能丧失或因胃肠道疾病住院无关。四分之三报告有中度至非常重度疼痛的患者未开具镇痛药。此外，74%因疼痛影响工作的患者没有镇痛药处方。
透析患者及其医疗服务提供者可能会从完善现有指南以及重新认识镇痛药的合理处方中获益。
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