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Ann Intern Med:长期阿片类药物治疗减剂量或停药后患者结局如何?

2017-09-04 吴星 环球医学

专家指南推荐当风险超过获益时,应当减少或停止长期阿片类药物治疗(LTOT),但减剂量对患者结局影响的证据还没有被系统评价过。2017年8月,发表在《Ann Intern Med.》的一项系统评价调查了LTOT减剂量或停药后的患者结局。



专家指南推荐当风险超过获益时,应当减少或停止长期阿片类药物治疗(LTOT),但减剂量对患者结局影响的证据还没有被系统评价过。2017年8月,发表在《Ann Intern Med.》的一项系统评价调查了LTOT减剂量或停药后的患者结局。

目的:对考察处方LTOT治疗慢性疼痛的成人减少或停止LTOT策略的有效性和减剂量后患者结局的研究进行综合。

数据出处:MEDLINE、EMBASE、PsycINFO、CINAHL和Cochrane Library从建库至2017年4月;参考文献列表;并联系专家。

研究筛选:以英文发表,考察LTOT减剂量或停药治疗慢性疼痛的原创性研究。

数据提取:2名独立的评价者使用美国预防服务工作组质量等级评定标准提取数据和评估研究质量。所有作者使用GRADE(证据推荐分级的评估、制订与评价)系统评价证据质量。预定义患者结局指标为疼痛的强度、功能、生活质量、阿片类药物戒断症状、药物滥用和不良事件。

数据合成:确定67项考察包括跨学科疼痛、丁丙诺啡辅助减少剂量和行为干预在内的8个干预类的研究(11项随机试验和56项观察性研究)。3项研究的研究质量较高,13项研究的研究质量一般,51项研究的研究质量较差。许多研究报告了剂量减少,但不同干预的阿片停药率范围较广,总证据质量较低。在考察减剂量后患者结局的40项研究中(总证据质量非常低),报告疼痛强度(所有8项质量一般的研究)、功能(所有5项质量一般的研究)和生活质量(所有3项质量一般的研究)的改善。

局限性:干预和干预测量异质性;非对照设计的质量较差的研究。

结论:非常低质量的证据显示,一些干预类型或能降低或停止LTOT,随着阿片类剂量的降低,疼痛、功能和生活质量或改善。

原始出处

Frank JW, et al. Patient Outcomes in Dose Reduction or Discontinuation of Long-Term Opioid Therapy: A Systematic Review. Ann Intern Med. 2017 Aug 1;167(3):181-191. doi: 10.7326/M17-0598. Epub 2017 Jul 11.

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    2017-09-06 lhlxtx
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    2017-09-06 yinhl1980
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    2017-09-04 184****9840

    学习了谢谢分享

    0

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    2017-09-04 惠映实验室

    学习了.谢谢.

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    2017-09-04 Y—xianghai

    学习了新知识

    0

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