在创伤中比较胺和吗啡的辅助医生止痛 (PACKMaN):一个随机的,双盲的,第三阶段试验
Michael A Smyth1,2, Hannah Noordali1, Kath Starr1
1University of Warwick, Gibbett Hill Road, Coventry CV4 7 AL, UK.
The Lancet regional health. Europe
|April 18, 2025
概括
与严重创伤疼痛的吗啡相比,护理人员管理的胺并没有提供更好的缓解疼痛. 这两种止痛药在PACKMaN试验中表现出类似的疗效和安全性,这表明需要进一步研究.
科学领域:
- 紧急医疗 紧急医疗
- 临床药理学 临床药理学
- 创伤护理 创伤护理
背景情况:
- 吗啡是一种常见的强烈止痛药,用于创伤疼痛,但具有低血压和呼吸系统抑郁等风险.
- 胺为急性疼痛管理提供了一个潜在的替代品,具有快速发作和有利的副作用概况.
- 对于重度创伤的护理人员来说,最佳的止痛选择仍然是积极调查的领域.
研究的目的:
- 为了比较基胺与救护人员在创伤患者中治疗严重疼痛的吗啡的临床有效性.
- 评估胺胺在医院前创伤护理中作为吗啡的替代品的疗效和安全性.
主要方法:
- PACKMaN试验是一项双盲,随机控制的优越性试验,涉及两家英国救护车服务.
- 在16岁以上的449名患有严重急性伤害疼痛 (NRS ≥7) 的患者中,随机分配给接受胺 (高达30毫克) 或吗啡 (高达20毫克) 静脉注射或骨内注射.
- 主要结局是抵达医院时的疼痛强度差异总和 (SPID) 评分,根据治疗意图进行分析.
主要成果:
- 在胺 (SPID 3.5) 和吗啡 (SPID 3.4) 之间没有发现有效性的显著差异.
- 严重不良事件的发生率很低,在各组之间是相似的 (2%的胺和3%的吗啡).
- 两组患者中的很大一部分在抵达医院后仍然感到疼痛.
结论:
- 在重度创伤中,氨酸在医院前止痛方面并不优于吗啡.
- 在这种情况下,胺和吗啡都显示出可比的疗效和安全性.
- 需要进一步的研究来改善创伤患者的疼痛管理策略,因为目前的选择使许多人留下残留疼痛.
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