Boitor Madalina, Ballard Ariane, Emed Jessica, Le May Sylvie, Gélinas Céline
Faculty of Dentistry, McGill University, Montreal, Quebec, Canada.
Faculty of Nursing, University of Montreal, Montreal, Quebec, Canada.
Can J Pain. 2020 May 21;4(1):103-110. doi: 10.1080/24740527.2020.1714431.
: Opioids are commonly prescribed to hospitalized adults to promote adequate pain relief, yet they can cause potentially fatal respiratory depression. : The aim of this study was to examine the risk factors for the development of severe opioid-induced respiratory depression (OIRD) in hospitalized adults to ensure adequate monitoring of high-risk patients. : A retrospective case-control study was conducted using data from the medical records of a university-affiliated hospital in Canada. Cases were eligible if they were adults (≥18 years old) and received opioid analgesia within 24 h of naloxone administration for respiratory depression. Controls had the same eligibility criteria, except for respiratory depression and naloxone administration. The case-control ratio was 1:1, and they were matched based on sex, type of unit, opioid molecule and the presence/absence of medication errors. : A total of 133 cases and 133 controls were included. Following cumulative risk factor analysis, renal failure (odds ratio [OR] = 2.176, 95% confidence interval [CI], 1.021-4.640, = 0.044), the first 24 h of opioid administration (OR = 1.899, 95% CI, 1.090-3.309, = 0.024), concomitant central nervous system (CNS) depressants (OR = 1.785, 95% CI, 1.023-3.113, = 0.041), and increasing age (OR = 1.019, 95% CI, 1.002-1.035, = 0.028) were positively associated with severe OIRD. : Some adult hospitalized patients were at higher risk of experiencing severe OIRD, such as those with renal failure, those in their first 24 h of opioid administration, those receiving CNS depressants in addition to opioids, and those with an advanced age. These results will assist with the screening of patients at higher risk for severe OIRD, which is key to implementing appropriate monitoring and enhancing the safety of opioid use in hospital settings.
阿片类药物通常被开给住院成人以促进充分的疼痛缓解，但它们可能导致潜在致命的呼吸抑制。本研究的目的是检查住院成人发生严重阿片类药物引起的呼吸抑制（OIRD）的危险因素，以确保对高危患者进行充分监测。使用加拿大一所大学附属医院的病历数据进行了一项回顾性病例对照研究。如果患者为成年人（≥18岁）且在因呼吸抑制给予纳洛酮后24小时内接受阿片类镇痛，则符合病例标准。对照组具有相同的纳入标准，但排除呼吸抑制和纳洛酮给药情况。病例对照比为1:1，根据性别、科室类型、阿片类药物分子以及是否存在用药错误进行匹配。共纳入133例病例和133例对照。经过累积危险因素分析，肾衰竭（比值比[OR]=2.176，95%置信区间[CI]，1.021 - 4.640，P = 0.044）、阿片类药物给药的最初24小时（OR = 1.899，95% CI，1.090 - 3.309，P = 0.024）、同时使用中枢神经系统（CNS）抑制剂（OR = 1.785，95% CI，1.023 - 3.113，P = 0.041）以及年龄增长（OR = 1.019，95% CI，1.002 - 1.035，P = 0.028）与严重OIRD呈正相关。一些住院成年患者发生严重OIRD的风险较高，例如肾衰竭患者、阿片类药物给药最初24小时内的患者、除阿片类药物外还接受CNS抑制剂的患者以及老年患者。这些结果将有助于筛查严重OIRD高危患者，这是在医院环境中实施适当监测并提高阿片类药物使用安全性的关键。
