Department of Pharmaceutical and Administrative Sciences, St Louis College of Pharmacy, University of Health Sciences and Pharmacy, 1 Pharmacy Place, St. Louis, MO, 63110, USA.
Pharmacy Department, Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand.
Int J Clin Pharm. 2022 Dec;44(6):1296-1303. doi: 10.1007/s11096-022-01460-1. Epub 2022 Jul 27.
Opioid-induced sedation and respiratory depression (OSRD) is a potentially life-threatening side effect of opioid analgesia. However, little is known about the individual and clinical-related factors associated with OSRD in the New Zealand context.
To identify risk factors for OSRD in patients admitted to a large regional health board in New Zealand-Auckland District Health Board (ADHB).
A retrospective matched case-control study design was undertaken among adults who were admitted to ADHB and prescribed opioids in hospital between August 2015 and April 2020. Those who were prescribed opioids and received naloxone for OSRD were defined as cases, whereas those who received opioids but did not experience OSRD were identified as controls. Cases and controls were matched on a 1:1 basis by age (± 10 years). Data were retrieved from the electronic medical records of ADHB. A conditional logistic regression model was used to identify the risk factors for OSRD.
We identified 51 cases, and these were matched with 51 control patients. The odds of experiencing OSRD were four times higher among opioid-naïve patients compared to those exposed to opioids prior to hospital admission (OR 4.113; 95% CI 1.14-14.89). Increased risk of OSRD was also associated with higher serum creatinine level prior to OSRD episode (OR 1.015; 95% CI 1.01-1.03) and a higher oral morphine milligram equivalent (OME) (OR 1.023; 95% CI 1.01-1.04).
Increased risk of OSRD was associated with a higher OME, a higher serum creatinine level prior to OSRD episode, and opioid naivety. Our findings can inform policies that aim to prevent serious adverse effects related to opioids.
阿片类药物引起的镇静和呼吸抑制（OSRD）是阿片类药物镇痛的一种潜在危及生命的副作用。然而，在新西兰背景下，人们对与 OSRD 相关的个体和临床相关因素知之甚少。
确定在新西兰奥克兰地区卫生局（ADHB）住院并接受阿片类药物治疗的患者发生 OSRD 的危险因素。
对 2015 年 8 月至 2020 年 4 月期间在 ADHB 住院并接受阿片类药物治疗的成年人进行回顾性匹配病例对照研究设计。那些接受阿片类药物治疗并因 OSRD 接受纳洛酮治疗的患者被定义为病例，而那些接受阿片类药物治疗但未发生 OSRD 的患者被确定为对照。病例和对照按年龄（±10 岁）进行 1:1 匹配。数据从 ADHB 的电子病历中检索。使用条件逻辑回归模型确定 OSRD 的危险因素。
我们确定了 51 例病例，并与 51 例对照患者进行了匹配。与入院前接触过阿片类药物的患者相比，阿片类药物初治患者发生 OSRD 的几率高 4 倍（OR 4.113；95%CI 1.14-14.89）。OSRD 发作前血清肌酐水平升高（OR 1.015；95%CI 1.01-1.03）和较高的口服吗啡毫克当量（OME）（OR 1.023；95%CI 1.01-1.04）也与发生 OSRD 的风险增加相关。
OSRD 风险增加与较高的 OME、OSRD 发作前的血清肌酐水平升高以及阿片类药物初治相关。我们的发现可以为旨在预防与阿片类药物相关的严重不良反应的政策提供信息。
