Vollstedt Annah, Rezaee Michael E, Monga Manoj, Zampini Anna, Krambeck Amy E, Shah Ojas, Sur Roger L, Chew Ben H, Eisner Brian, Pais Vernon
Clin Nephrol. 2020 Jun;93(6):269-274. doi: 10.5414/CN109991.
To investigate the main reasons for use of opioids during acute episodes of renal colic and for ureteral stent symptoms post-operatively.
A survey assessing the impact of decreased quality of life and use of opioid pain medication was distributed to patients with a history of ureteral stent at seven academic centers between July 2016 and June 2018.
A total of 365 surveys were completed. Opioid use for stone (63.9%) and stent-related pain (39.0%) was common among respondents. When assessing whether patients used more opioids for stone or stent-related pain, 47.7% reported using more for stone pain while 15.0% reported using more for stent pain. 22.6% of patients required opioids for stent-related pain and not stone pain. Increasing patient age was found to be negatively associated with using opioids for stent-related pain (OR: 0.4, 95% CI: 0.3 - 0.6). Increasing age was also found to be negatively associated with opioid use for stone pain (OR: 0.6, 95% CI: 0.4 - 0.8). Patients with a greater number of prior stones had 3.2 times the odds of using opioids for stone pain, in our adjusted model (95% CI: 2.1 - 4.7).
Patients with more prior stone episodes are more likely to have used opioids for their most recent episode. Although ureteral stents have been shown to be associated with a decreased quality of life, we showed that the use of opioids for stent-related pain is less than that for stone pain. Younger patients are less likely to tolerate a stent without opioid analgesics.
探究肾绞痛急性发作期间使用阿片类药物以及术后输尿管支架症状的主要原因。
2016年7月至2018年6月期间,在七个学术中心向有输尿管支架置入史的患者发放了一份评估生活质量下降影响及阿片类止痛药物使用情况的调查问卷。
共完成365份调查问卷。在受访者中,因结石(63.9%)和支架相关疼痛(39.0%)使用阿片类药物的情况较为常见。在评估患者是否因结石或支架相关疼痛使用更多阿片类药物时,47.7%的患者表示因结石疼痛使用更多,而15.0%的患者表示因支架疼痛使用更多。22.6%的患者因支架相关疼痛而非结石疼痛需要使用阿片类药物。研究发现,患者年龄增加与因支架相关疼痛使用阿片类药物呈负相关(比值比:0.4,95%置信区间:0.3 - 0.6)。年龄增加也与因结石疼痛使用阿片类药物呈负相关(比值比:0.6,95%置信区间:0.4 - 0.8)。在我们的校正模型中,既往结石数量较多的患者因结石疼痛使用阿片类药物的几率是其他患者的3.2倍(95%置信区间:2.1 - 4.7)。
既往有更多结石发作史的患者在最近一次发作时更有可能使用阿片类药物。尽管输尿管支架已被证明与生活质量下降有关,但我们的研究表明,因支架相关疼痛使用阿片类药物的情况少于因结石疼痛使用的情况。年轻患者在没有阿片类镇痛药的情况下更难以耐受支架。