Department of Clinical Science University of Bergen Bergen Norway.
Institute of Clinical Medicine University of Bergen Bergen Norway.
Brain Behav. 2017 Nov 19;7(12):e00869. doi: 10.1002/brb3.869. eCollection 2017 Dec.
The aim of this study was to investigate how the use of analgesics, sleeping drugs, and sedatives relates to prognosis and complications in stroke patients in the acute care phase (≤48 hr) after a stroke.
Patients with ischemic stroke, hemorrhagic stroke, and transient ischemic attack were included. The study is based on gathering of data on medication from 921 patient records belonging to patients included in the Bergen NORSTROKE registry, 12.2009-02.2012. In this database risk factors, stroke severity, etiology, and blood analyses were prospectively registered. We have retrospectively registered if patients received one drug or more from a list of analgesics, sleeping drugs, and sedatives within the first 48 hr after admission.
In total, 921 patients were included in the study, 408 females and 513 males. Mean age was 71.0 years. In total, 101 patients were given sleeping drugs, 97 patients sedatives and 140 patients analgesics. Of the group given analgesics, 90 patients were given codeine-containing analgesics. Logistic regression analyses showed that codeine-containing analgesics were associated with an increased occurrence of pneumonia (OR = 3.8, < .001), stroke worsening (OR = 2.7, = .001), and a higher mRS-score (OR = 2, = .024) day 7. The study did not show any relation between poorer prognosis or increased occurrence of complications and the use of other analgesics, sedatives and/or sleeping drugs.
Use of codeine-containing analgesics is associated with a poorer short-term prognosis and an increased occurrence of complications in the acute phase after a stroke. The highly significant findings suggest that codeine has a negative effect on acute stroke patients. The study reflects exploratory analyses and prospective studies are necessary to determine the background of the association observed in our study.
本研究旨在探讨急性脑卒患者在卒中后急性期（≤48 小时）使用镇痛药、助眠药和镇静剂与预后和并发症的关系。
纳入缺血性卒、出血性卒和短暂性脑缺血发作患者。本研究基于对来自 Bergen NORSTROKE 登记处的 921 例患者病历中药物使用数据的收集，时间为 2009 年 12 月至 2012 年 2 月。该数据库中前瞻性登记了危险因素、卒严重程度、病因和血液分析。我们回顾性登记了患者在入院后 48 小时内是否使用了一系列镇痛药、助眠药和镇静剂中的一种或多种药物。
本研究共纳入 921 例患者，其中女性 408 例，男性 513 例，平均年龄为 71.0 岁。共有 101 例患者使用了助眠药，97 例患者使用了镇静剂，140 例患者使用了镇痛药。在使用镇痛药的患者中，90 例使用了含可待因的镇痛药。Logistic 回归分析显示，含可待因的镇痛药与肺炎的发生（OR=3.8，<0.001）、卒恶化（OR=2.7，=0.001）和第 7 天 mRS 评分升高（OR=2，=0.024）相关。该研究未显示使用其他镇痛药、镇静剂和/或助眠药与预后较差或并发症发生率增加之间存在任何关系。
使用含可待因的镇痛药与急性卒后短期预后较差和并发症发生率增加相关。这一显著发现表明可待因对急性卒患者有负面影响。该研究反映了探索性分析，需要进行前瞻性研究以确定我们研究中观察到的关联的背景。
