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CMAJ:儿童术后疼痛家庭管理:口服吗啡不优于布洛芬

2017-11-28 何娜 环球医学

2017年10月,发表在《CMAJ》上的一项随机对照试验,考察了在儿童术后疼痛家庭管理过程中口服吗啡是否优于布洛芬。

2017年10月,发表在《CMAJ》上的一项随机对照试验,考察了在儿童术后疼痛家庭管理过程中口服吗啡是否优于布洛芬。

背景:口服吗啡常用于小儿外科手术后的疼痛,虽然其越来越普遍,但却没有证据支持。研究人员评估了在儿童术后疼痛家庭管理上口服吗啡是否优于布洛芬。

方法:研究人员开展了一项随机、优效性试验,对比了5-17岁经历小型门诊骨科手术(2013年6月至2016年9月)的儿童口服吗啡(0.5 mg/kg)与布洛芬(10 mg/kg)的效果。受试者每6 h接一次干预药物最多给予8剂。主要结局是第1剂后的疼痛,其依据面部表情评分法-修订版。次要结局包括额外止痛药的需求、不良反应、未计划的健康护理就诊和2-8剂后的疼痛评分。

结果:研究人员分析了每个吗啡和布洛芬组的77名受试者的数据。两个干预降低的疼痛评分没有差异。吗啡和布洛芬的第1剂前后的疼痛评分的差异中位数均是1(四分位间距是0-1)(p=0.2)。对于2-8剂,给药前后疼痛差异的中位数没有显着差异。服用吗啡的受试者报道显着较多的不良事件(45/65[69%] vs 26/67[39%],p<0.001),且最常见的是困倦(吗啡和布洛芬组分别为31/65[48%] vs 15/67[22%];p=0.003)。

结论:吗啡不优于布洛芬,两种药物都能减轻疼痛,但疗效没有显着差异。吗啡与较多的副作用显着相关,这表明布洛芬是小型手术后更好的一线选择。

原始出处:
Poonai N, Datoo N, Ali S, et al.Oral morphine versus ibuprofen administered at home for postoperative orthopedic pain in children: a randomized controlled trial.CMAJ. 2017 Oct 10;189(40):E1252-E1258. doi: 10.1503/cmaj.170017.

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