年龄对机械通气患者芬太尼和吗啡镇痛镇静临床剂量等效性的影响：来自 ANALGESIC 试验的结果。
The effect of age on clinical dose equivalency of fentanyl and morphine analgosedation in mechanically ventilated patients: Findings from the ANALGESIC trial.
机构信息
Department of Intensive Care, Austin Hospital, Melbourne, Australia; Department of Intensive Care, Northern Hospital, Melbourne, Australia; Department of Critical Care, University of Melbourne, Melbourne, Australia.
Department of Intensive Care, Northern Hospital, Melbourne, Australia; Department of Critical Care, University of Melbourne, Melbourne, Australia; Department of Medical Education, University of Melbourne, Melbourne, Australia.
出版信息
Aust Crit Care. 2024 Mar;37(2):236-243. doi: 10.1016/j.aucc.2023.07.001. Epub 2023 Aug 11.
BACKGROUND
The dose equivalency of fentanyl vs. morphine is widely considered to be approximately 1:100. However, little is known about the effect of age on this ratio when these agents are used as infusions for analgosedation.
OBJECTIVES
To assess the impact of age on the clinical dose equivalency of fentanyl and morphine when used as infusions for analgosedation in mechanically ventilated intensive care unit patients.
METHODS
We performed a post hoc analysis of the Assessment of Opioid Administration to Lead to Analgesic Effects and Sedation in Intensive Care (ANALGESIC) cluster randomised crossover trial of fentanyl and morphine infusions for analgosedation. Dose and analgosedative clinical equivalency of fentanyl and morphine were assessed by age and by using different body-size descriptors.
RESULTS
We studied 663 patients (338 fentanyl, 325 morphine). Median (interquartile range) hourly dose of fentanyl and morphine were 58.1 (40.0-89.2) mcg and 3400 (2200-5000) mcg, respectively. The ratio of total dose of fentanyl:morphine was 1:93 in the 18- to 29-year-old group and 1:25 in the ≥80-year-old group (p = 0.015), respectively, with fentanyl becoming relatively less clinically effective as age increased. This effect was also seen when comparing dosing by different body-size descriptors with the strongest age-related change when using body surface area as body-size descriptor (p = 0.009).
CONCLUSION
The analgosedative clinical dose equivalency of fentanyl vs. morphine is heterogeneous when used as infusions for analgosedation, with fentanyl becoming relatively less clinically effective as age increases. This information can help guide prescription of these agents during transition from one agent to the other in critically ill patients.
背景
芬太尼与吗啡的剂量等效比通常被认为约为 1:100。然而，当这些药物作为镇静镇痛输注药物用于机械通气重症监护病房患者时，关于年龄对该比值影响的了解甚少。
目的
评估年龄对芬太尼和吗啡作为镇静镇痛输注药物用于机械通气重症监护病房患者时的临床剂量等效比的影响。
方法
我们对芬太尼和吗啡输注用于镇静镇痛的阿片类药物镇痛和镇静作用评估（ANALGESIC）的多中心随机交叉试验进行了事后分析。通过年龄和不同的体型描述符评估芬太尼和吗啡的剂量和镇静镇痛临床等效性。
结果
我们研究了 663 名患者（芬太尼 338 例，吗啡 325 例）。芬太尼和吗啡的中位（四分位间距）每小时剂量分别为 58.1（40.0-89.2）μg和 3400（2200-5000）μg。18-29 岁组和≥80 岁组的芬太尼总剂量：吗啡剂量比分别为 1:93 和 1:25（p=0.015），随着年龄的增长，芬太尼的临床疗效相对降低。当比较不同体型描述符的剂量时，也观察到了这种效果，当使用体表面积作为体型描述符时，年龄相关性变化最强（p=0.009）。
结论
当用于镇静镇痛输注时，芬太尼与吗啡的镇静镇痛临床剂量等效比是不均匀的，随着年龄的增长，芬太尼的临床疗效相对降低。这些信息可以帮助指导在危重患者从一种药物过渡到另一种药物时这些药物的处方。
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