Webster Lynn R, Karan Suzanne
PRA Health Sciences, Salt Lake City, UT, USA.
University of Rochester Medical Center, Rochester, NY, USA.
Pain Ther. 2020 Dec;9(2):467-486. doi: 10.1007/s40122-020-00203-2. Epub 2020 Oct 6.
Chronic pain is one of the most common reasons adults seek medical care and is often managed with opioid analgesics; however, opioids may cause respiratory depression by suppressing various components of respiration. Respiration is the physiological process that facilitates gas exchange and is mediated through the proper function of and communication among central neural control (respiratory drive), sensory input systems, the lungs, and the muscles involved in respiration. Normal respiratory function can be dampened with the use of central nervous system (CNS) depressants and/or underlying health conditions. Patients with chronic pain are often exposed to CNS depressants other than opioids, including benzodiazepines, barbiturates, nonbenzodiazepine sedative-hypnotics, and ethanol, which can function synergistically with opioids to increase the risk of respiratory depression. Some patients may also have underlying health issues, such as obstructive sleep apnea, that can be exacerbated with the use of opioids and other CNS depressants and further contribute to respiratory depression. Clinicians should have a thorough understanding of respiration, recognize how various CNS depressants suppress it, and take necessary steps to mitigate the risk of opioid-induced respiratory depression by collaborating with a multidisciplinary team (i.e., sleep and pain specialists), choosing appropriate medications, and educating patients on the proper use and storage of opioids.
慢性疼痛是成年人寻求医疗护理的最常见原因之一，通常使用阿片类镇痛药进行治疗；然而，阿片类药物可能通过抑制呼吸的各个组成部分而导致呼吸抑制。呼吸是促进气体交换的生理过程，通过中枢神经控制（呼吸驱动）、感觉输入系统、肺以及参与呼吸的肌肉的正常功能和相互作用来介导。使用中枢神经系统（CNS）抑制剂和/或潜在的健康状况可能会削弱正常的呼吸功能。慢性疼痛患者经常接触除阿片类药物之外的CNS抑制剂，包括苯二氮䓬类、巴比妥类、非苯二氮䓬类镇静催眠药和乙醇，这些药物可与阿片类药物协同作用，增加呼吸抑制的风险。一些患者可能还存在潜在的健康问题，如阻塞性睡眠呼吸暂停，使用阿片类药物和其他CNS抑制剂可能会使其加重，并进一步导致呼吸抑制。临床医生应全面了解呼吸，认识到各种CNS抑制剂如何抑制呼吸，并通过与多学科团队（即睡眠和疼痛专家）合作、选择合适的药物以及对患者进行阿片类药物正确使用和储存的教育等必要措施，来降低阿片类药物引起的呼吸抑制风险。
