阿片类药物相关间隔综合征及相关发病率。

Opioid-related compartment syndrome and associated morbidity.

机构信息

Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 N. Caroline Street, Baltimore, MD 21287, USA.

出版信息

Injury. 2019 Aug;50(8):1429-1432. doi: 10.1016/j.injury.2019.06.013. Epub 2019 Jun 13.

DOI:10.1016/j.injury.2019.06.013

PMID:31279477

Abstract

INTRODUCTION

Opioid-related compartment syndrome (ORCS) is an understudied complication related to opioid overdose. We hypothesized that ORCS would be associated with worse clinical outcomes, including higher amputation rates, need for multiple surgical procedures, and rhabdomyolysis on admission, compared with nonopioid-related compartment syndrome (NORCS).

METHODS

We used Current Procedural Terminology codes for fasciotomy as a proxy marker for cases of compartment syndrome treated at 1 health system from January 1, 2016, to December 21, 2018. We excluded patients younger than 18 years, those treated for exertional compartment syndrome, and those who underwent elective fasciotomies. Seventy-four patients met our inclusion criteria. Data reviewed included patient characteristics, cause of compartment syndrome, time until evaluation for compartment syndrome, peak creatinine kinase levels, number of surgical procedures required, duration of hospital stay, and postoperative inpatient morbidity and death. Patients were categorized as having ORCS (n = 8) or NORCS (n = 66). Alpha = .05.

RESULTS

All cases of ORCS occurred in men. Opioid use was the third most common cause of compartment syndrome. Two patients underwent amputation, both in the ORCS group (p <  0.01). The median number of debridements was significantly higher for the ORCS group (median, 4; interquartile range [IQR]: 3-6) than for the NORCS group (median, 3; IQR 2-4) (p =  0.03). Duration of hospital stay was longer for the ORCS group (median, 27 days; IQR 16-38) compared with the NORCS group (median, 9 days; IQR: 5-13) (p <  0.001). Mean (± standard deviation) peak creatinine kinase level was significantly higher in the ORCS group (224,000 ± 225,052 U/L) compared with the NORCS group (7550 ± 32,500) (p <  0.001). The proportion of patients who underwent hemodialysis was higher in the ORCS group (88%) than in the NORCS group (35%) (p <  0.001). All ORCS patients presented >8 h after immobilization in a dependent position.

CONCLUSION

Patients in the ORCS group had delayed presentations and significantly more morbidity compared with patients in the NORCS group.

摘要

简介

阿片类药物相关间隔综合征（ORCS）是一种与阿片类药物过量相关的研究较少的并发症。我们假设与非阿片类药物相关间隔综合征（NORCS）相比，ORCS 与更差的临床结局相关，包括更高的截肢率、需要多次手术以及入院时的横纹肌溶解症。

方法

我们使用 1 个医疗系统从 2016 年 1 月 1 日至 2018 年 12 月 21 日的筋膜切开术的当前程序术语 (CPT) 代码作为治疗间隔综合征的病例的代理标记。我们排除了年龄小于 18 岁的患者、因劳累性间隔综合征接受治疗的患者和接受选择性筋膜切开术的患者。有 74 名患者符合我们的纳入标准。审查的数据包括患者特征、间隔综合征的原因、评估间隔综合征的时间、肌酸激酶峰值水平、所需手术次数、住院时间以及术后住院期间的发病率和死亡。患者分为 ORCS 组（n=8）和 NORCS 组（n=66）。α值=0.05。

结果

所有 ORCS 病例均发生在男性中。阿片类药物的使用是间隔综合征的第三大常见原因。有 2 名患者接受了截肢，均在 ORCS 组（p<0.01）。ORCS 组的中位数清创次数明显高于 NORCS 组（中位数，4；四分位距 [IQR]：3-6）（p=0.03）。ORCS 组的住院时间（中位数，27 天；IQR：16-38）明显长于 NORCS 组（中位数，9 天；IQR：5-13）（p<0.001）。ORCS 组的平均（±标准偏差）肌酸激酶峰值水平明显高于 NORCS 组（224,000±225,052 U/L）（p<0.001）。ORCS 组接受血液透析的患者比例（88%）明显高于 NORCS 组（35%）（p<0.001）。所有 ORCS 患者在依赖位置固定后>8 小时出现症状。