Green Robert, Bulloch Blake, Kabani Amin, Hancock Betty Jean, Tenenbein Milton
Department of Emergency Medicine, Dalhousie University, Halifax, Canada.
Pediatrics. 2005 Oct;116(4):978-83. doi: 10.1542/peds.2005-0273.
The objectives of this study were to determine whether the administration of morphine to children with acute abdominal pain would impede the diagnosis of appendicitis and to determine the efficacy of morphine in relieving the pain.
This was a double-blind, randomized, placebo-controlled trial involving 5- to 16-year-old children who presented to the emergency department of a children's hospital with a chief complaint of acute abdominal pain that was thought by the pediatric emergency attending physician to require a surgical consultation. Subjects were randomized to receive intravenously administered morphine or normal saline solution. Clinical data and the emergency physician's confidence in his or her clinical diagnosis (0-100%) were recorded systematically with a standardized form. This was repeated 15 minutes after administration of the study medication. The surgeon assessed the child within 1 hour and completed a similar data collection sheet. Pain was assessed, with a color analog scale, before and after study medication administration. Each subject was monitored for 2 weeks after enrollment.
One hundred eight children were enrolled; 52 received morphine and 56 received a placebo saline solution. There were no differences between groups in demographic variables or the degree of pain. There were no differences between groups in the diagnoses of appendicitis or perforated appendicitis or the number of children who were observed and then underwent laparotomy. The reduction in the mean pain score was significantly greater in the morphine group (2.2 vs 1.2 cm). The emergency physicians' and surgeons' confidence in their diagnoses was not affected by the administration of morphine.
Our data show that morphine effectively reduces the intensity of pain among children with acute abdominal pain and morphine does not seem to impede the diagnosis of appendicitis.
本研究的目的是确定给急性腹痛儿童使用吗啡是否会妨碍阑尾炎的诊断，并确定吗啡缓解疼痛的疗效。
这是一项双盲、随机、安慰剂对照试验，纳入了5至16岁因急性腹痛为主诉到儿童医院急诊科就诊的儿童，儿科急诊主治医师认为这些儿童需要外科会诊。受试者被随机分为静脉注射吗啡组或生理盐水组。临床数据以及急诊医生对其临床诊断的信心（0-100%）使用标准化表格进行系统记录。在给予研究药物15分钟后重复记录。外科医生在1小时内对儿童进行评估，并完成类似的数据收集表。在给予研究药物前后，使用彩色模拟量表评估疼痛程度。每个受试者在入组后监测2周。
共纳入108名儿童；52名接受吗啡，56名接受安慰剂生理盐水。两组在人口统计学变量或疼痛程度方面无差异。两组在阑尾炎或穿孔性阑尾炎的诊断以及观察后接受剖腹手术的儿童数量方面无差异。吗啡组平均疼痛评分的降低显著更大（2.2 vs 1.2 cm）。急诊医生和外科医生对其诊断的信心不受吗啡给药的影响。
我们的数据表明，吗啡可有效降低急性腹痛儿童的疼痛强度，且吗啡似乎不会妨碍阑尾炎的诊断。
