Age is the best predictor of postoperative morphine requirements
Age is the best predictor of postoperative morphine requirements
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DOI：
10.1016/0304-3959(95)00128-x
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发表时间：
1996-02-01
期刊：
影响因子：
7.4
通讯作者：
Jarvis, DA
中科院分区：
文献类型：
--
作者：
Macintyre, PE;Jarvis, DA
用于术后疼痛缓解的阿片类药物剂量传统上是基于患者的体重。尽管通常建议70岁以上的老年患者减少剂量，但通常不考虑年轻患者的年龄相关剂量改变。1010例患者的记录，70岁以下，通过病人自控镇痛（PCA）的大手术后处方吗啡进行了检查，看看哪些因素可能最好地预测吗啡的使用量在手术后的第一个24小时。包括的因素包括年龄、性别、体重、手术部位、语言数字疼痛评分（休息和运动时）和恶心/呕吐评分。在78例患者的亚组中，术中和恢复室阿片类药物剂量的影响尽管PCA吗啡剂量的患者间变异性很大，（每个年龄组的差异高达10-fofd），术后24小时内PCA吗啡需求的最佳预测因子（初始负荷剂量后24小时内所需的量）是患者的年龄。对于20岁以上的患者，这些需求的估计可以从以下公式获得：平均前24小时吗啡需求（mg）= 100 - age APCA允许患者灵活地滴定他们自己的阿片类药物剂量;如果常规镇痛方案要变得更有效，它们也需要允许剂量需求的广泛患者间差异。虽然以前的研究已经注意到患者年龄和所需阿片类药物量之间的相关性，但这项研究量化了这种相关性，并为阿片类药物给药提供了指导。常规镇痛方案的处方应包括以上述公式获得的值为中心的剂量范围，以考虑到每个年龄组患者间的较大差异。虽然最初的吗啡剂量应根据患者的年龄而不是体重来指导，但随后的剂量仍然必须根据效果进行滴定。
The dose of opioid prescribed for postoperative pain relief has traditionally been based on the weight of the patient. Although a reduction in dose is often suggested for elderly patients over 70 years of age, age-related alterations to dose are generally not considered for younger patients. The records of 1010 patients, under 70 years old, prescribed morphine via patient-controlled analgesia (PCA) after major operations were examined to see what factors might best predict the amount of morphine used in the first 24 h after surgery. Factors included were age, sex, weight, operative site, verbal numeric pain score (at rest and on movement) and a nausea/vomiting score. In a subgroup of 78 of these patients, the effects of intraoperative and recovery room doses of opioid ('clinical' loading dose) were analysed.Although the interpatient variability in PCA morphine doses was large (differences of up to 10-fofd in each age group), the best predictor of PCA morphine requirement in the first 24 h after surgery (the amount required in the 24 h after the initial loading dose) was the age of the patient. An estimate of these requirements for patients over the age of 20 years can be obtained from the formula: average first 24 h morphine requirement (mg) = 100 - age.PCA allows patients the flexibility to titrate their own opioid dose; if conventional analgesic regimens are to become more effective, they too need to allow for the wide interpatient variation in dose requirements. Although previous studies have noted a correlation between patient age and the amount of opioid needed, this study quantifies this correlation and provides guidelines for opioid dosing. Prescriptions for conventional analgesic regimens should include a dose range centred on values obtained from the above formula to allow for the large interpatient variation in each age group. While initial morphine dose should be guided by patient age and not weight, subsequent doses must still be titrated according to effect.