Koury Katharine M, Tsui Becky, Gulur Padma
Massachusetts General Hospital, Boston, MA.
Pain Physician. 2015 Jan-Feb;18(1):E27-30.
There has been a recent surge in the literature highlighting the association of fentanyl as precipitating serotonin syndrome in patients on a serotonergic agent.
The purpose of our study was to understand the incidence of serotonin syndrome in patients who receive fentanyl while on serotonergic agents.
This retrospective analysis was conducted from 2012 to 2013 after approval from the Institutional Review Board. We searched for all patients that had received a serotonergic agent and were admitted to the hospital during the study period. Next, we split these patients into 2 groups by placing all patients who had received fentanyl and a serotonergic agent into one group. We then searched for any of the Hunter Serotonin Toxicity Criteria in the records of patients that had received both fentanyl and a serotonergic agent. Further, we searched for all patients with serotonin syndrome mentioned in their records.
This study was conducted at a 900 bed tertiary care academic center.
Over the 2 year study period, 112,045 patients were on a serotonergic agent, and 4,538 of these patients were treated with both fentanyl and a serotonergic agent. A search for Hunter's Criteria through the records of the patients receiving both fentanyl and a serotonergic agent revealed 23 patients had been documented with some of these symptoms. On detailed chart review, only 4 [95% CI 1 - 10] of these patients truly met Hunter's Criteria for serotonin syndrome. We then searched all admissions for a diagnosis code of serotonin syndrome during the study period. Five additional cases of serotonin syndrome were found, but none of these patients were treated with fentanyl.
Some of the limitations of our study include that it represents a single institution, although it is a large academic center. An inherent limitation may be the under diagnosis of serotonin syndrome.
The incidence of serotonin syndrome in patients who receive both fentanyl and a serotonergic agent is low.
近期文献中大量涌现出关于在使用血清素能药物的患者中，芬太尼引发血清素综合征的相关报道。
我们研究的目的是了解在使用血清素能药物的同时接受芬太尼治疗的患者中血清素综合征的发生率。
本回顾性分析在获得机构审查委员会批准后，于2012年至2013年进行。我们搜索了在研究期间接受血清素能药物并入院的所有患者。接下来，我们将所有接受过芬太尼和血清素能药物的患者分为一组，其余患者分为另一组。然后，我们在接受过芬太尼和血清素能药物的患者记录中查找任何符合亨特血清素中毒标准的情况。此外，我们还在所有患者记录中搜索提及血清素综合征的患者。
本研究在一家拥有900张床位的三级医疗学术中心进行。
在为期2年的研究期间，有112,045名患者使用血清素能药物，其中4,538名患者同时接受了芬太尼和血清素能药物治疗。通过对接受芬太尼和血清素能药物的患者记录进行亨特标准搜索，发现有23名患者记录有部分这些症状。经过详细的病历审查，这些患者中只有4名[95%置信区间1 - 10]真正符合亨特血清素综合征标准。然后，我们在研究期间的所有入院记录中搜索血清素综合征的诊断代码。又发现了5例血清素综合征病例，但这些患者均未接受芬太尼治疗。
我们研究的一些局限性包括，尽管这是一个大型学术中心，但它仅代表单一机构。一个内在的局限性可能是血清素综合征的诊断不足。
同时接受芬太尼和血清素能药物治疗的患者中血清素综合征的发生率较低。
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