术后应用阿洛司琼的疗效：两种剂量方案的比较。

Efficacy of alvimopan following bowel resection: a comparison of two dosing strategies.

机构信息

University of Louisville Health Care, Louisville, KY, USA.

出版信息

Ann Pharmacother. 2013 Nov;47(11):1406-13. doi: 10.1177/1060028013504289.

DOI:10.1177/1060028013504289

PMID:24285757

Abstract

BACKGROUND

Alvimopan is indicated to accelerate the time to gastrointestinal recovery following partial bowel resection with primary anastomosis. The approved dosing regimen includes an initial dose prior to surgery and 12 mg twice daily after surgery for up to 7 days; however, there are no human studies evaluating the need for the preoperative dose. We report our experience with gastrointestinal recovery when the preoperative dose is omitted.

OBJECTIVE

To evaluate the efficacy of alvimopan therapy when the preoperative dose is not administered.

METHODS

This retrospective study included elective surgery patients who underwent bowel resection with primary anastomosis without colostomy or ileostomy. The study compared (a) patients who received alvimopan and received a dose preoperatively, (b) patients who received alvimopan but did not receive a dose preoperatively, and (c) matched control patients who did not receive alvimopan. Length of stay following bowel resection, direct hospital costs, time to first bowel movement, and time to oral diet were evaluated.

RESULTS

Of 50 patients who received alvimopan, 27 received the preoperative dose and 23 did not. These 50 patients were matched to similar control patients who received no alvimopan during their admission for resection. Compared with controls, time to discharge was significantly shorter in patients who received alvimopan, regardless of whether the preoperative dose was administered (P < .001) or omitted (P = .03). Patients who did not receive the preoperative dose still experienced faster time to first bowel movement (71 vs 97 hours; P = .006) and faster time to first diet (17 vs 54 hours; P < .001) than non-alvimopan users.

CONCLUSION

Patients receiving the approved alvimopan dosing regimen experienced the most rapid recovery of gastrointestinal function. However, administering alvimopan only postoperatively (if the preoperative dose is omitted) may still reduce the severity of postoperative ileus.

摘要

背景

阿维莫潘用于加速部分肠切除术后的胃肠恢复，伴或不伴一期吻合。阿维莫潘的批准剂量方案包括手术前的初始剂量和手术后每日两次 12 毫克，最多 7 天；然而，没有人体研究评估术前剂量的必要性。我们报告了在省略术前剂量时胃肠恢复的经验。

目的

评估省略术前剂量时阿维莫潘治疗的疗效。

方法

本回顾性研究纳入了行肠切除伴一期吻合术而无结肠造口术或回肠造口术的择期手术患者。该研究比较了（a）接受阿维莫潘且术前给予剂量的患者，（b）接受阿维莫潘但未术前给予剂量的患者，以及（c）未接受阿维莫潘的匹配对照患者。评估了肠切除术后的住院时间、直接住院费用、首次肠蠕动时间和开始口服饮食的时间。

结果

在 50 例接受阿维莫潘的患者中，27 例接受了术前剂量，23 例未接受。这 50 例患者与在其入院接受切除术期间未接受阿维莫潘的类似对照患者相匹配。与对照组相比，接受阿维莫潘的患者无论是否给予术前剂量（P<0.001）或省略（P=0.03），其出院时间均显著缩短。未接受术前剂量的患者仍经历更快的首次肠蠕动时间（71 小时对 97 小时；P=0.006）和首次饮食时间（17 小时对 54 小时；P<0.001）。