성인 중환자에서 마약성 진통제 중단 증후군에 대한 후향적 코호트 연구

Abstract

Background: Opioid withdrawal syndrome (OWS) may occur following the reduction or discontinuation of opioid analgesics. In critically ill pediatric patients, OWS is a common and clinically significant condition. As OSW in adult patients has not been assessed in detail, this study aimed to investigate the incidence, risk factors, and clinical features of OWS in patients treated in an adult intensive care unit (ICU). Methods: This study was a retrospective evaluation of data from patients treated in the medical ICU for ≥ 3 days and who received only one type of opioid analgesic. OWS was assessed over a 24 hour period from discontinuation or reduction (by > 50%) of continuous opioid infusion. OWS was defined as the presence of ≥ 3 central nervous system or autonomic nervous system symptoms. Results: In 126 patients treated with remifentanil (n = 58), fentanyl (n = 47), or morphine (n = 21), OWS was seen in 31.0%, 36.2%, and 9.5% of patients, respectively (p = 0.078). The most common symptom was a change in respiratory rate (remifentanil, 94.4%; fentanyl, 76.5%; morphine, 100%). Multivariate Cox-proportional hazards model showed that OWS was associated with morphine treatment (hazard ratio: 0.17, 95% CI: 0.037–0.743) and duration of opioid infusion (hazard ratio: 0.566, 95% CI: 0.451–0.712). Conclusions: No statistically significant difference in the incidence of OWS was observed among patients treated with different types of opioid analgesics, although a lower frequency was seen in patients receiving morphine. Prospective studies are required to confirm these preliminary results.