Jasani N B, O'Conner R E, Bouzoukis J K
Department of Emergency Medicine, Medical Center of Delaware, Wilmington 19899, USA.
Acad Emerg Med. 1994 Nov-Dec;1(6):539-43. doi: 10.1111/j.1553-2712.1994.tb02549.x.
To compare the efficacies of meperidine and hydromorphone in the treatment for ureteral colic in the emergency department (ED).
A prospective, double-blind, randomized clinical trial was conducted over six months at a tertiary referral center with 93,000 annual ED visits. Seventy-three patients completed the study. The patients received either 1 mg of hydromorphone or 50 mg of meperidine IV at t = 0. Pain intensity was determined using a 10-cm visual analog scale at t = 0, 15, 30, 60, and 120 minutes. A second dose of the study drug could be given between t = 15 and t = 120 minutes when the clinician believed the initial dose was ineffective. Patients requiring more than one additional dose of analgesia were treated as nonresponders and were removed from the study.
Thirty-six patients received hydromorphone and 37 received meperidine. The initial pain intensities (hydromorphone group = 8.4 +/- 1.5; meperidine group = 8.5 +/- 2.1), age distributions, sex distributions, and side effects of the two groups were comparable. Pain relief was better (p < 0.05) with hydromorphone at t = 15, 30, 60, and 120 minutes. The hydromorphone group required rescue analgesia less often (31% vs 68%, p < 0.01), had fewer IV pyelographies (IVPs) (28% vs 54%, p < 0.05), and had a lower proportion of hospital admissions (25% vs 49%, p = 0.08).
For the fixed doses used in this study, the adult ureteral colic patients receiving hydromorphone achieved more pain relief, required less rescue medication, underwent fewer IVPs, and avoided hospital admission more frequently than did those receiving meperidine.
比较哌替啶和氢吗啡酮在急诊科治疗输尿管绞痛的疗效。
在一家年急诊量达93000人次的三级转诊中心进行了一项为期6个月的前瞻性、双盲、随机临床试验。73例患者完成了研究。患者在t = 0时静脉注射1mg氢吗啡酮或50mg哌替啶。在t = 0、15、30、60和120分钟时，使用10厘米视觉模拟量表测定疼痛强度。当临床医生认为初始剂量无效时，可在t = 15至t = 120分钟之间给予第二剂研究药物。需要额外一剂以上镇痛药物的患者被视为无反应者，并被排除在研究之外。
36例患者接受氢吗啡酮治疗，37例接受哌替啶治疗。两组的初始疼痛强度（氢吗啡酮组=8.4±1.5；哌替啶组=8.5±2.1）、年龄分布、性别分布和副作用具有可比性。在t = 15、30、60和120分钟时，氢吗啡酮的镇痛效果更好（p < 0.05）。氢吗啡酮组需要抢救性镇痛的频率更低（31%对68%，p < 0.01），静脉肾盂造影（IVP）更少（28%对54%，p < 0.05），住院比例更低（25%对49%，p = 0.08）。
对于本研究中使用的固定剂量，与接受哌替啶的成年输尿管绞痛患者相比，接受氢吗啡酮的患者疼痛缓解更明显，需要的抢救药物更少，接受的IVP更少，且更频繁地避免了住院。
