Pace S, Burke T F
Department of Emergency Medicine, MCHJ-EM, Madigan Army Medical Center, Fort Lewis, WA 98431, USA.
Acad Emerg Med. 1996 Dec;3(12):1086-92. doi: 10.1111/j.1553-2712.1996.tb03365.x.
To determine whether morphine affects evaluation or outcome for patients with acute abdominal pain.
Prospective, double-blind, placebo-controlled administration of morphine sulfate (MS) or normal saline (NS) in the setting of acute abdominal pain. The study was performed at a military ED with an annual census of 60,000 visits. Patients > or = 18 years old who had abdominal pain for < or = 48 hours were included. Patients who were allergic to MS or who had systolic blood pressures < 90 mm Hg were excluded. The physicians indicated a provisional diagnosis, a differential diagnosis, and a provisional disposition. Study solution was titrated to the patient's assessment of adequate analgesia (up to a volume equivalent of 20 mg of MS); pain response was monitored using a visual analog scale (VAS). The patients were followed until diagnosis occurred or symptoms resolved.
Of 75 patients enrolled, 71 completed the study; 35 patients received MS and 36 received NS. More than half (44; 62%) of the patients were admitted from the ED; 28 patients underwent surgery. The VAS pain level improved more for the MS group, 3.9 +/- 2.8 cm, than it did for the NS group, 0.8 +/- 1.5 cm (p < 0.01). Study solution dose was less in the MS group than it was in the NS group, 1.5 +/- 0.5 mL vs 1.8 +/- 0.4 mL (p < 0.01). There was no difference between the groups when comparing accuracy of provisional or differential diagnosis with that of final diagnosis. Differences between provisional and actual dispositions were the same in all groups. There were 3 diagnostic or management errors in each group.
When compared with saline placebo, the administration of MS to patients with acute abdominal pain effectively relieved pain and did not alter the ability of physicians to accurately evaluate and treat patients.
确定吗啡是否会影响急性腹痛患者的评估或治疗结果。
在急性腹痛患者中进行前瞻性、双盲、安慰剂对照的硫酸吗啡（MS）或生理盐水（NS）给药。该研究在一家年就诊量为60000人次的军队急诊科进行。纳入年龄≥18岁、腹痛≤48小时的患者。排除对MS过敏或收缩压<90mmHg的患者。医生给出初步诊断、鉴别诊断和初步处置意见。研究溶液根据患者对充分镇痛的评估进行滴定（最大体积相当于20mg的MS）；使用视觉模拟量表（VAS）监测疼痛反应。对患者进行随访直至确诊或症状缓解。
75名入组患者中，71名完成了研究；35名患者接受了MS，36名患者接受了NS。超过一半（44名；62%）的患者从急诊科入院；28名患者接受了手术。MS组的VAS疼痛水平改善程度更大，为3.9±2.8cm，而NS组为0.8±1.5cm（p<0.01）。MS组的研究溶液剂量低于NS组，分别为1.5±0.5mL和1.8±0.4mL（p<0.01）。比较初步诊断或鉴别诊断与最终诊断的准确性时，两组之间没有差异。所有组中初步处置与实际处置的差异相同。每组有3例诊断或管理错误。
与生理盐水安慰剂相比，对急性腹痛患者使用MS可有效缓解疼痛，且不会改变医生准确评估和治疗患者的能力。
