阿片类药物是否会影响急性腹痛患者的临床评估?
Sumant R Ranji1, L Elizabeth Goldman, David L Simel
1Department of Medicine, University of California, San Francisco, CA 94143-0131, USA. sumantr@medicine.ucsf.edu
JAMA
|October 13, 2006
概括
片止痛药可能会改变急性腹痛的体检结果,但不会显著增加管理错误. 这项研究发现,在接受疼痛缓解治疗的患者中,与阿片类药物使用相关的重大发病率或死亡率没有发现.
科学领域:
- 紧急医疗 紧急医疗
- 临床药理学 临床药理学
背景情况:
- 传统上,阿片类止痛药一直被拒绝给急性腹痛患者,直到经过手术评估后.
- 这种做法源于担心缓解疼痛可能会掩盖身体发现并使诊断复杂.
研究的目的:
- 评估阿片类止痛药对临床检查和急性腹痛手术决定的影响.
- 确定疼痛管理是否会影响诊断准确性和手术结果.
主要方法:
- 通过MEDLINE,EMBASE和文献搜索识别的安慰剂受控随机试验的系统审查.
- 研究的重点是治疗急性腹痛的阿片类止痛,报告病史的变化,体检或诊断错误.
- 数据提取和质量评估由两名审查员独立进行,第三名审查员解决了差异.
主要成果:
- 在成人和儿童中,阿片类药物给药显示出改变腹部检查结果的趋势.
- 当专注于具有显著止痛作用的试验时,体检变化变得具有统计学意义 (RR,2.13;95% CI,1.14至3.98).
- 然而,阿片类药物使用与管理错误 (例如,不必要或延迟的手术) 的增加没有显著关联,绝对增加的小幅度为+0.3% (95% CI, -4.1%至+4.7%).
结论:
- 虽然阿片类止痛药可以改变急性腹痛的体检结果,但它们不会导致管理错误的显著增加.
- 现有的文献并不排除小幅增加的错误,但这是基于保守的定义.
- 在审查的研究中,没有任何主要的发病率或死亡率与阿片类药物管理有关.
相关概念视频
01:16Antianginal Drugs: Nitrates and β-Blockers
In cardiovascular health, antianginal drugs combat angina pectoris — a condition marked by chest pain owing to diminished blood flow to the heart.
Organic nitrates, such as nitroglycerin, play a pivotal role. Once metabolized, they liberate nitric oxide, a molecular marvel. Nitric oxide triggers guanylyl cyclase and augments cGMP production. This biochemical cascade orchestrates the relaxation of vascular smooth muscles, ushering in vasodilation and enhancing coronary blood flow. Administered...
Organic nitrates, such as nitroglycerin, play a pivotal role. Once metabolized, they liberate nitric oxide, a molecular marvel. Nitric oxide triggers guanylyl cyclase and augments cGMP production. This biochemical cascade orchestrates the relaxation of vascular smooth muscles, ushering in vasodilation and enhancing coronary blood flow. Administered...
01:25Analgesia and Pain Management
Pain is critical to various clinical pathologies, provoking an urgent need for effective management. Pain, whether acute or chronic, is a complex neurochemical process. Its alleviation depends on the type, with nonopioid analgesics effective for mild to moderate pain, such as musculoskeletal or inflammatory pain, while neuropathic pain responds best to anticonvulsants, tricyclic antidepressants, or serotonin/norepinephrine reuptake inhibitors. For severe acute or chronic pain, opioids may be...
01:23Drugs Affecting GI Tract Motility: Serotonin Receptor Agonists
Serotonin, a crucial neurotransmitter synthesized by enterochromaffin cells, plays a cardinal role in regulating gastrointestinal (GI) motility. With over 90% of the body's total serotonin in the GI tract, its influence on digestive processes is profound. Serotonin is swiftly released upon various stimuli, such as food boluses or certain drugs, triggering intrinsic sensory neurons in the myenteric plexus and extrinsic vagal and spinal sensory neurons. This leads to the activation of the...
01:27Chemotherapy-Induced Nausea and Vomiting: 5-HT3 Receptor Antagonists
5-HT3 receptor antagonists, such as dolasetron, granisetron (Kytril), ondansetron (Zofran), and palonosetron (Axoli), are crucial in managing chemotherapy-induced nausea and vomiting (CINV) and postoperative nausea. These drugs selectively block 5-HT3 receptors in the visceral vagal and spinal afferent nerves, chemoreceptor trigger zone, and the vomiting center. They have a rapid onset of action and can be given as a single dose before chemotherapy. Ondansetron and granisetron, in particular,...
01:26Peptic Ulcer Disease IV: Management
Medical treatment strategies for peptic ulcers encompass various methods. The primary goal of treatment is to diminish gastric acidity and strengthen mucosal defense mechanisms.
The therapeutic approach involves ensuring adequate rest, implementing drug therapy, promoting smoking cessation, making dietary modifications, and emphasizing long-term follow-up care.
Pharmacological management
The prevailing therapy for peptic ulcers involves a combination of managing the patient's current medication...
The therapeutic approach involves ensuring adequate rest, implementing drug therapy, promoting smoking cessation, making dietary modifications, and emphasizing long-term follow-up care.
Pharmacological management
The prevailing therapy for peptic ulcers involves a combination of managing the patient's current medication...
01:08Effect of Hepatic Disease on Pharmacokinetics: Dose Adjustments Due to Hepatic Impairment
Hepatic impairment, characterized by decreased liver function, does not uniformly mandate adjustments in drug dosage. Whether dosage modifications are necessary depends on various factors related to the drug's metabolism and elimination pathways. If a drug is primarily excreted via the kidneys and bypasses significant hepatic processing, if it undergoes minimal metabolic transformation in the liver, or if it is volatile and primarily expelled through the lungs, dose adjustments may not be...