摘要
目的 探讨健康社会决定因素(SDOH)对腰椎退行性变患者阿片类药物使用的影响.方法 选择2020年1月至2022年12月在我院接受腰椎融合术治疗的腰椎退行性疾病患者203例作为研究对象,根据术前3个月内是否服用阿片类药物将患者分为阿片类药物应用组(OU组)69例和非阿片类药物应用(NOU组)134例.观察两组患者一般资料、术中与术后资料、SDOH和健康相关行为(HRB),采用多因素Logistic回归分析探讨影响术前和术后阿片类药物应用的风险因素.结果 OU组与NOU组患者的脊柱手术史、体质量指数(BMI)、糖尿病、高血压、焦虑/抑郁、ASA分级、住院时间、年龄、工作状态、家庭月收入、吸烟、活动量方面存在统计学差异(P＜0.05).多因素Logistic回归分析显示,失业、活动量低、低收入(＜5千元/月)是术前阿片类药物应用的风险因素(P＜0.05).OU组患者术后3个月、术后1年时的阿片类药物应用率均高于NOU组患者(P＜0.05),OU组术后平均阿片类药物用量高于NOU组(P＜0.05).多因素Logistic回归分析结果显示,术前阿片类药物应用、饮酒、低收入水平是影响术后阿片类药物应用的风险因素(P＜0.05).结论 择期手术的腰椎退行性变患者中,活动量低、低收入、失业与术前阿片类药物使用相关,术前阿片类药物使用是术后阿片类药物使用的重要风险因素.
Abstract
Objective To study the impact of social determinants of health(SDOH)on perioperative opioid use in patients with lumbar degenerative disease.Methods 203 patients with lumbar degenerative disease who underwent lumbar fusion surgery in our hospital from January 2020 to December 2022 were selected as the research subjects.Based on whether they took opioid drugs within 3 months before surgery,the patients were divided into opioid users(OU group)with 69 cases and non opioid users(NOU group)with 134 cases.General information,intraoperative and postoperative data,SDOH,and health-related behavior(HRB)were observed in two groups of patients,and risk factors affecting preoperative and postoperative opioid drug use were analyzed using multivariate logistic analysis.Results There were statistically significant differences between OU patients and NOU patients in spinal surgery history,BMI,diabetes,hypertension,anxiety/depression,ASA classification,length of hospital stay,age,working status,family monthly in-come,smoking,and lung capacity(P＜0.05).Multivariate logistic analysis showed that unemployment,low activity,and low income(＜5000 yuan/month)were risk factors for preoperative opioid use(P＜0.05).The use rate of opioid drugs in the OU group was higher than that in the NOU group at 3 months and 1 year after surgery(P＜0.05),and the average postoperative use of opioid drugs in the OU group was higher than that in the NOU group(P＜0.05).The results of multivariate logistic analysis showed that preopera-tive use of opioids,alcohol consumption,and low income levels were risk factors affecting postoperative use of opioids(P＜0.05).Conclusion Among patients with lumbar degenerative disease undergoing elective surgery,low activity,low income,and unemploy-ment are associated with preoperative opioid use.Preoperative opioid use is an important risk factor for postoperative opioid use.
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