Pawasauskas Jayne, Stevens Benjamin, Youssef Rouba, Kelley Michelle
Jayne Pawasauskas, Pharm.D., BCPS, is Clinical Associate Professor, University of Rhode Island College of Pharmacy, Kingston, and Clinical Pharmacy Consultant, Pain Management, Kent Hospital, Warwick, RI. Benjamin Stevens, Pharm.D., is Staff Pharmacist, Liberty Drug & Surgical, Chatham, NJ. Rouba Youssef, M.A., is a doctoral candidate in behavioral science, Department of Psychology, University of Rhode Island. Michelle Kelley, Pharm.D., is Clinical Coordinator of Pharmacy Services, Kent Hospital.
Am J Health Syst Pharm. 2014 May 1;71(9):746-50. doi: 10.2146/ajhp130568.
Results of a study to determine the established risk factors most closely associated with the use of naloxone to reverse adverse effects of opioid analgesia in a hospital population are presented.
In a retrospective case-control study at a community hospital, pharmacy dispensing records were used to identify 65 cases over a one-year period that involved the use of naloxone for the treatment of oversedation or respiratory depression and met the other inclusion criteria; another 65 patients who received opioid analgesia during the same period but did not require naloxone were identified as controls. The influence of demographics and clinical variables on the likelihood of naloxone use was analyzed by linear regression and chisquare testing.
Patients in the naloxone group had an average of 5 risk factors for opioid-induced oversedation or respiratory depression, compared with an average of 3.3 risk factors in the control group (p < 0.001). Five factors were significantly associated with naloxone use: comorbid renal disease (odds ratio [OR], 6.034; 95% confidence interval [CI], 2.565-14.195), cardiac disease (OR, 5.829; 95% CI, 2.687-12.642), respiratory disease (OR, 3.600; 95% CI, 1.742-7.441), concurrent use of central nervous system-sedating medication (OR, 4.750; 95% CI, 1.949-11.578), and positive smoking status (OR, 4.7421; 95% CI, 2.114-9.256).
Hospitalized patients on general medical units who required naloxone to reverse opioid-induced oversedation or respiratory depression had significantly more risk factors than matched patients who did not require naloxone.
本研究呈现了一项关于确定与在医院人群中使用纳洛酮逆转阿片类镇痛药物不良反应密切相关的既定风险因素的研究结果。
在一家社区医院进行的回顾性病例对照研究中，利用药房配药记录在一年时间内识别出65例涉及使用纳洛酮治疗过度镇静或呼吸抑制且符合其他纳入标准的病例；同期接受阿片类镇痛药物治疗但不需要纳洛酮的另外65例患者被确定为对照。通过线性回归和卡方检验分析人口统计学和临床变量对使用纳洛酮可能性的影响。
纳洛酮组患者平均有5个阿片类药物引起过度镇静或呼吸抑制的风险因素，而对照组平均有3.3个风险因素（p<0.001）。五个因素与使用纳洛酮显著相关：合并肾病（比值比[OR]，6.034；95%置信区间[CI]，2.565 - 14.195）、心脏病（OR，5.829；95%CI，2.687 - 12.642）、呼吸系统疾病（OR，3.600；95%CI，1.742 - 7.441）、同时使用中枢神经系统镇静药物（OR，4.750；95%CI，1.949 - 11.578）以及吸烟状态为阳性（OR，4.7421；95%CI，2.114 - 9.256）。
需要纳洛酮逆转阿片类药物引起的过度镇静或呼吸抑制的普通内科病房住院患者，其风险因素显著多于不需要纳洛酮的匹配患者。
