东莨菪碱用药后院内不良事件综合分析:利用全国大型住院患者数据库开展的回顾性队列研究的启示。

IF 2.3 3区 医学 Q2 ANESTHESIOLOGY
George Sun, Marc C Torjman, Kevin J Min
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引用次数: 0

摘要

背景:东莨菪碱是麻醉实践中广泛使用的止吐药,尤其适用于术后和出院后的恶心和呕吐。尽管东莨菪碱的使用频率很高,疗效也得到了认可,但人们担心其副作用可能会增加,尤其是在老年患者中。需要进一步研究以评估安全性并确定不良事件的年龄阈值。本研究假设围手术期东莨菪碱的使用与更差的临床结果、肺炎增加、谵妄、尿潴留和再入院之间存在关联:利用TriNetX分析网络数据库对2009年1月1日至2018年3月21日期间接受大型外科手术的患者进行了一项大型回顾性队列研究,以考察围手术期使用东莨菪碱对院内不良事件的影响。患者被分为不同年龄组,并与对照组进行比较。评估的主要结果包括谵妄、肺炎、院内死亡、新用抗精神病药、再入院和术后7天内新发尿潴留。为减少偏差,进行了 1:1 倾向评分匹配。估算了相对风险和风险差异及95%置信区间:经过1:1倾向得分匹配后,我们共确定了403816人(201908对)围手术期东莨菪碱使用者和非使用者。其中,20-29 岁、30-39 岁、40-49 岁、50-59 岁、60-69 岁和 70 岁以上的患者分别为 22,910 人(11,455 对)、44,170 人(22,085 对)、58,590 人(29,295 对)、71,660 人(35,830 对)、88,386 人(44,193 对)和 118,100 人(59,050 对)。在所有年龄较大的队列中,经过倾向评分匹配后,围手术期服用东莨菪碱的患者发生谵妄、肺炎、院内死亡、新用抗精神病药、再入院和新发尿潴留的相对风险和风险差异均显著增加:在这项队列研究中,围手术期使用东莨菪碱与院内不良事件风险的显著增加有关,无论是在70岁以上的队列中,还是在大手术后的20-29岁、30-39岁、40-49岁、50-59岁和60-69岁的队列中。这些发现凸显了仔细评估东莨菪碱风险和益处的必要性,尤其是对于40岁及以上的患者。东莨菪碱可能最适合用于非卧床患者出院后的恶心和呕吐,临床医生应重新评估其在术后恶心和呕吐中的标准用法,倾向于使用副作用较少的短效药物。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A comprehensive analysis of in-hospital adverse events after scopolamine administration: insights from a retrospective cohort study using a large nationwide inpatient database.

Background: Scopolamine is a widely used antiemetic in anesthetic practice, particularly for postoperative and post-discharge nausea and vomiting. Despite its frequent usage and recognized efficacy, concerns have emerged regarding the potential for increased side effects, particularly in elderly patients. Further research is needed to assess safety and determine age thresholds for adverse events. This study hypothesizes associations between perioperative scopolamine use, worse clinical outcomes, increased pneumonia, delirium, urinary retention, and readmissions.

Methods: A large, retrospective cohort study was performed using the TriNetX Analytics Network database on patients undergoing major surgical procedures between Jan 1, 2009, and March 21, 2018, to examine the impact of perioperative scopolamine use on in-hospital adverse events. Patients were divided into age groups and compared to a control group. The primary outcomes assessed were delirium, pneumonia, in-hospital death, new antipsychotic use, readmission, and new onset urinary retention within 7 days post-surgery. 1:1 propensity score matching was performed to reduce bias. Relative risk and risk differences with 95% confidence intervals were estimated.

Results: After 1:1 propensity score matching, we identified a total of 403,816 (201,908 pairs) perioperative scopolamine users and nonusers. The cohorts of 20-29, 30-39, 40-49, 50-59, 60-69, and 70 + contained 22,910 (11,455 pairs), 44,170 (22,085 pairs), 58,590 (29,295 pairs), 71,660 (35,830 pairs), 88,386 (44,193 pairs), and 118,100 (59,050 pairs) patients respectively. Across older age cohorts, after propensity score matching, perioperative scopolamine recipients had significantly increased relative risk and risk difference of delirium, pneumonia, in-hospital mortality, new antipsychotic use, readmission, and new-onset urinary retention.

Conclusions: In this cohort study, perioperative scopolamine usage was associated with a significantly increased risk of in-hospital adverse events, both within the 70 + age cohort and among the 20-29, 30-39, 40-49, 50-59, and 60-69 age cohorts after major surgery. These findings highlight the need for careful assessment of scopolamine's risks and benefits, especially for patients aged 40 and older. Scopolamine may be most suited for post-discharge nausea and vomiting in ambulatory patients and clinicians should reassess its standard use for postoperative nausea and vomiting, favoring shorter-acting agents with fewer side effects.

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来源期刊
BMC Anesthesiology
BMC Anesthesiology ANESTHESIOLOGY-
CiteScore
3.50
自引率
4.50%
发文量
349
审稿时长
>12 weeks
期刊介绍: BMC Anesthesiology is an open access, peer-reviewed journal that considers articles on all aspects of anesthesiology, critical care, perioperative care and pain management, including clinical and experimental research into anesthetic mechanisms, administration and efficacy, technology and monitoring, and associated economic issues.
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