Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon 97239, USA.
Prehosp Emerg Care. 2010 Apr-Jun;14(2):167-75. doi: 10.3109/10903120903572301.
Fentanyl has several potential advantages for out-of-hospital analgesia, including rapid onset, short duration, and less histamine release. Objective. To compare the effectiveness and safety of fentanyl with that of morphine.
This was a retrospective before-and-after study of a protocol change from morphine to fentanyl in an advanced life support emergency medical services system in January 2007. Charts from nine months prior to the change and for nine months afterward were abstracted by two reviewers using a standardized instrument. The first three months after the change were excluded. Effectiveness was measured by change in pain scores on a 0-10 scale. A priori-defined adverse events included out-of-hospital events: respiratory rate <12 breaths/min, pulse oximetry <92%, systolic blood pressure <90 mmHg, any fall in Glasgow Coma Scale score, nausea or vomiting, intubation, and use of antiemetic agents or naloxone. Emergency department charts were reviewed for initial pain scores and the same adverse events during the first two hours. Events clearly not attributable to the opioid were discounted. The changes in pain scores were also compared adjusting for confounders by multivariable linear regression.
Three hundred fifty-five patients aged 13 to 99 years received morphine during the nine months before the protocol change and 363 received fentanyl following the washout period. Initial pain scores for morphine (8.1) and fentanyl (8.3) were comparable (95% confidence interval [CI] for difference -1.1 to 0.3). Fentanyl patients received a higher equivalent dose of opioid (7.7 mg morphine equivalents for morphine, 9.2 mg for fentanyl, CI for the difference 0.9 to 2.3). The mean decreases in pain score were similar between the drugs (2.9 for morphine, 3.1 for fentanyl, CI for the difference -0.3 to 0.7). With regard to adverse events, 9.9% of the morphine patients and 6.6% of the fentanyl patients experienced an adverse event in the field (CI for the difference -0.8 to 7.3%). The most common event was nausea, with a rate of 7.0% for morphine vs. 3.8% for fentanyl (CI for the difference -0.1% to 6.5%).
Morphine and fentanyl provide similar degrees of out-of-hospital analgesia, although this was achieved with a higher dose of fentanyl. Both medications had low rates of adverse events, which were easily controlled.
芬太尼在院外镇痛方面具有多种潜在优势，包括起效迅速、作用时间短和组胺释放较少。目的：比较芬太尼与吗啡的疗效和安全性。
这是一项回顾性的前瞻性研究，于 2007 年 1 月对先进的生命支持急救医疗服务系统中的方案从吗啡改为芬太尼。由两名审核员使用标准化工具从方案改变前的九个月和改变后的九个月摘录图表。改变后的前三个月被排除在外。有效性通过 0-10 刻度的疼痛评分变化来衡量。预先定义的不良事件包括院外事件：呼吸频率<12 次/分钟、脉搏血氧饱和度<92%、收缩压<90mmHg、格拉斯哥昏迷量表评分任何下降、恶心或呕吐、插管以及使用止吐药或纳洛酮。审查急诊病历以了解初始疼痛评分以及前两个小时内出现的相同不良事件。明显与阿片类药物无关的事件被排除在外。通过多变量线性回归调整混杂因素后，还比较了疼痛评分的变化。
355 名 13 至 99 岁的患者在方案改变前的九个月内接受吗啡治疗，363 名患者在洗脱期后接受芬太尼治疗。吗啡（8.1）和芬太尼（8.3）的初始疼痛评分相当（差值置信区间为-1.1 至 0.3）。芬太尼患者接受的阿片类药物等效剂量更高（吗啡为 7.7mg 吗啡当量，芬太尼为 9.2mg，差值置信区间为 0.9 至 2.3）。两种药物的疼痛评分平均下降幅度相似（吗啡为 2.9，芬太尼为 3.1，差值置信区间为-0.3 至 0.7）。关于不良事件，9.9%的吗啡患者和 6.6%的芬太尼患者在现场发生不良事件（差值置信区间为-0.8 至 7.3%）。最常见的事件是恶心，吗啡发生率为 7.0%，芬太尼为 3.8%（差值置信区间为-0.1%至 6.5%）。
吗啡和芬太尼提供相似程度的院外镇痛，尽管芬太尼需要更高的剂量。两种药物的不良事件发生率均较低，且易于控制。
