Safety of benzodiazepines and opioids in very severe respiratory disease: national prospective study.
Safety of benzodiazepines and opioids in very severe respiratory disease: national prospective study.
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DOI：
10.1136/bmj.g445
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发表时间：
2014-01-30
期刊：
影响因子：
--
通讯作者：
Currow DC
中科院分区：
文献类型：
--
作者：
Ekström MP;Bornefalk-Hermansson A;Abernethy AP;Currow DC
目的评价苯二氮卓类药物与阿片类药物治疗极重度慢性阻塞性肺疾病（COPD）的安全性。设计基于人群的纵向连续队列研究。在瑞典开设长期氧疗中心。2005年至2009年期间，瑞典国家Swedevox登记册中有2249例患者开始长期氧疗治疗COPD。主要结果测量苯二氮卓类药物和阿片类药物对住院率和死亡率的影响，校正了年龄、性别、动脉血气、体重指数（BMI）、体力状态、既往住院史、合并症和合并用药。结果1681例（76%）患者入院治疗，1129例（50%）在观察期内死亡。无患者失访。苯二氮卓类药物和阿片类药物与入院率增加无关：风险比分别为0.98（95%置信区间，0.87 ~ 1.10）和0.98（0.86 ~ 1.10）。苯二氮卓类药物与死亡率增加相关（1.21，1.05 - 1.39），并具有剂量反应趋势。阿片类药物也与死亡率存在剂量反应关系：与较高剂量阿片类药物（1.21，1.02 - 1.44）相比，较低剂量阿片类药物（≤30 mg口服吗啡当量/天）与死亡率增加无关（1.03，0.84 - 1.26）。低剂量的苯二氮卓类和阿片类药物合并用药与入院率（0.86，0.53 - 1.42）或死亡率（1.25，0.78 - 1.99）增加无关。关联性不因药物初治或高碳酸血症而改变。结论低剂量阿片类药物与COPD患者入院率或死亡率增加无关，在严重呼吸系统疾病中减轻症状可能是安全的。
Objective To evaluate the safety of benzodiazepines and opioids in patients with very severe chronic obstructive pulmonary disease (COPD). Design Population based longitudinal consecutive cohort study. Setting Centres prescribing long term oxygen therapy in Sweden. Patients 2249 patients starting long term oxygen therapy for COPD in Sweden between 2005 and 2009 in the national Swedevox Register. Main outcome measures Effects of benzodiazepines and opioids on rates of admission to hospital and mortality, adjusted for age, sex, arterial blood gases, body mass index (BMI), performance status, previous admissions, comorbidities, and concurrent drugs. Results 1681 (76%) patients were admitted to hospital, and 1129 (50%) died under observation. No patient was lost to follow-up. Benzodiazepines and opioids were not associated with increased admission: hazard ratio 0.98 (95% confidence interval, 0.87 to 1.10) and 0.98 (0.86 to 1.10), respectively. Benzodiazepines were associated with increased mortality (1.21, 1.05 to 1.39) with a dose response trend. Opioids also had a dose response relation with mortality: lower dose opioids (≤30 mg oral morphine equivalents a day) were not associated with increased mortality (1.03, 0.84 to 1.26) in contrast with higher dose opioids (1.21, 1.02 to 1.44). Concurrent benzodiazepines and opioids in lower doses were not associated with increased admissions (0.86, 0.53 to 1.42) or mortality (1.25, 0.78 to 1.99). Associations were not modified by being naive to the drugs or by hypercapnia. Conclusions Lower dose opioids are not associated with increased admissions or deaths in patients with COPD and might be safe for symptom reduction in severe respiratory disease.
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