van Voorthuizen T, Helmers J H, Tjoeng M M, Otten M H
Afd. Interne Geneeskunde, Ziekenhuis Eemland, Amersfoort.
Ned Tijdschr Geneeskd. 2000 Apr 1;144(14):656-8.
The most important symptom in acute pancreatitis is pain. This pain often is so severe that treatment is started with opioid analgesics. In daily practice meperidine is often the analgesic of first choice because it is supposed to cause less spasm of the M. sphincter ampullae hepatopancreaticae (sphincter of Oddi). Drawbacks of the use of meperidine compared with other opiods are myoclonias, tremors and convulsions due to accumulation of the metabolite norpethidine, and hypotension, tachycardia and erythema due to release of more histamine from mast cells. From literature study it appeared that all opioids have a spasmogenic effect on the sphincter of Oddi, that there are no good arguments to assume that this effect is less when meperidine is used, and that there is no good evidence that this spasmogenic effect of opioid analgesics influences the course of acute pancreatitis in an unfavourable way. Since the profile of effects and side effects of meperidine is unfavourable, we prefer the use of opioids with a larger therapeutic width.
急性胰腺炎最重要的症状是疼痛。这种疼痛通常非常剧烈，以至于治疗时首先使用阿片类镇痛药。在日常实践中，哌替啶常常是首选的镇痛药，因为它被认为引起肝胰壶腹括约肌（奥狄括约肌）痉挛的程度较轻。与其他阿片类药物相比，使用哌替啶的缺点包括：由于代谢产物去甲哌替啶的蓄积导致肌阵挛、震颤和惊厥，以及由于肥大细胞释放更多组胺而导致低血压、心动过速和红斑。从文献研究来看，似乎所有阿片类药物对奥狄括约肌都有促痉挛作用，没有充分理由认为使用哌替啶时这种作用会更小，也没有充分证据表明阿片类镇痛药的这种促痉挛作用会以不利方式影响急性胰腺炎的病程。由于哌替啶的效应和副作用情况不佳，我们更倾向于使用治疗窗更宽的阿片类药物。
