背景:睡眠相关疾病与疼痛有关,疲劳,和认知能力的缺陷,这可能会干扰成功的康复。研究目标是(1)量化与战斗相关的截肢后第一年的失眠药物的门诊处方,(2)检查失眠药物处方的纵向变化,和(3)分析与失眠药物处方相关的患者特征。
方法:这是一项回顾性研究,来自远征医疗遭遇数据集的DoD伤亡记录和来自药房数据交易服务的门诊药物处方。从2001年到2017年,共有1,651名美国军人在伊拉克和持久自由行动中进行了重大截肢手术,并在受伤后的第一年内接受了任何药物的门诊处方。推荐用于失眠的药物的处方是低剂量抗抑郁药,抗焦虑镇静剂,苯二氮卓类药物,褪黑素受体激动剂,和低剂量喹硫平.这些处方药按药物类型进行了分析,伤后时间,以及受伤后第一年的患者特征。
结果:在受伤后的第一年,78%的患者(1651人中的1291人)有失眠药物的门诊处方,主要是抗焦虑镇静药物(例如,唑吡坦),平均共86个处方日(中位数=66)。这些处方的流行率在第一年大幅下降,从受伤后第一季度的57%到第四季度的28%。在单变量分析中,多个患者特征,包括高伤害严重程度评分,持续的阿片类和非阿片类镇痛药处方,和慢性疼痛的诊断,情绪障碍,和创伤后应激障碍,与失眠药物的门诊处方的患病率和持续时间显着相关。
结论:目前的结果表明,与战斗相关的截肢后,门诊处方失眠药物的患病率很高,患病率大大高于以前报告的现役人员。这些发现可以为DVA/DoD提供军事亚群截肢护理和失眠的指南。结果突出表明,需要对遭受严重战斗伤害的患者在受伤后早期康复过程中失眠的治疗进行更多研究。
BACKGROUND: Sleep-related disorders are associated with pain, fatigue, and deficits in cognitive performance, which may interfere with successful rehabilitation. The study objectives were to (1) quantify outpatient prescriptions for insomnia medications during the first year following combat-related amputations, (2) examine longitudinal changes in prescriptions for insomnia medications, and (3) analyze patient characteristics associated with prescriptions for insomnia medications.
METHODS: This was a retrospective study of DoD casualty records from the Expeditionary Medical Encounter Dataset and prescriptions for outpatient medications from the Pharmacy Data Transaction Service. Patients were a total of 1,651 U.S. service members who sustained major limb amputations in Operations Iraqi and Enduring Freedom from 2001 through 2017 and had outpatient prescriptions for any medication during the first year postinjury. Prescriptions for medications recommended for insomnia were low-dose antidepressants, anxiolytic sedatives, benzodiazepines, melatonin receptor agonist, and low-dose quetiapine. These prescription medications were analyzed by medication type, postinjury time, and patient characteristics during the first year postinjury.
RESULTS: During the first year postinjury, 78% of patients (1,291 of 1,651) had outpatient prescriptions for insomnia medications, primarily anxiolytic sedative drugs (e.g., zolpidem), averaging a total of 86 prescription days (median = 66). The prevalence of these prescriptions declined substantially during the first year, from 57% of patients during the first quarter to 28% during the fourth quarter postinjury. In univariate analyses, multiple patient characteristics, including high Injury Severity Score, continued opioid and non-opioid analgesic prescriptions, and diagnoses of chronic pain, mood disorder, and posttraumatic stress disorder, were significantly associated with higher prevalence and duration of outpatient prescriptions for insomnia medications.
CONCLUSIONS: The present results indicate a high prevalence of outpatient prescriptions for insomnia medications following combat-related amputations, a prevalence that is substantially higher than previously reported among active duty personnel. These findings can inform DVA/DoD guidelines for amputation care and insomnia among military subpopulations. The results highlight the need for more research on the treatment of insomnia during early postinjury rehabilitation among patients who sustained serious combat injuries.