Cardiology Department, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
Department of Genetic Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
Clin Cardiol. 2021 Sep;44(9):1216-1224. doi: 10.1002/clc.23691. Epub 2021 Jul 8.
While morphine has long been widely used in treating acute heart failure (AHF) due to its vasodilatory properties and anticipated anxiolysis, it remains unclear whether the application of morphine to those patients is reasonable. We aim to conduct a systematic review and meta-analysis to assess the safety of morphine in patients with AHF. We searched PubMed, Cochrane Library, and Embase electronic databases from inception through March 2020. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were used to estimate the outcomes. Seven studies with 172, 226 patients were included. The results showed that morphine usage was not associated with increased in-hospital mortality (OR: 1.94; 95% CI 0.93 to 4.03; p = 0.08). However, the use of morphine significantly increased the risk of invasive ventilation (OR: 2.72; 95% CI 1.09 to 6.80; p = 0.03). Furthermore, the subgroup analysis indicated that the application of morphine was not associated with increased 7-day all-cause mortality in patients with AHF (OR: 1.69; 95% CI 0.80 to 3.22; p = 0.11) but significantly increased the risk of 30-day all-cause mortality (OR: 1.59; 95% CI 1.16 to 2.17; p = 0.004). Based on current evidence, our results suggested that although morphine therapy did not significantly increase the risk of short-term death (in the hospital or within 7 days) in patients with AHF, the risk of long-term death and invasive ventilation were significantly increased. This result needs to be further confirmed by an ongoing randomized control trial.
尽管吗啡具有血管扩张特性和预期的抗焦虑作用，长期以来被广泛用于治疗急性心力衰竭（AHF），但其在 AHF 患者中的应用是否合理仍不清楚。我们旨在进行系统评价和荟萃分析，以评估吗啡在 AHF 患者中的安全性。我们检索了 PubMed、Cochrane Library 和 Embase 电子数据库，检索时间从建库至 2020 年 3 月。使用合并优势比（OR）和 95%置信区间（CI）来估计结局。纳入了 7 项研究共 172226 例患者。结果表明，吗啡的使用与住院死亡率增加无关（OR：1.94；95%CI 0.93 至 4.03；p=0.08）。然而，吗啡的使用显著增加了有创通气的风险（OR：2.72；95%CI 1.09 至 6.80；p=0.03）。此外，亚组分析表明，吗啡的应用与 AHF 患者 7 天全因死亡率增加无关（OR：1.69；95%CI 0.80 至 3.22；p=0.11），但显著增加了 30 天全因死亡率的风险（OR：1.59；95%CI 1.16 至 2.17；p=0.004）。基于目前的证据，我们的结果表明，尽管吗啡治疗并未显著增加 AHF 患者短期死亡（住院或 7 天内）的风险，但长期死亡和有创通气的风险显著增加。这一结果需要通过正在进行的随机对照试验进一步证实。
