静脉利多卡因与氢吗啡酮治疗急性腹部疼痛的随机对照试验
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Randomized Trial of Intravenous Lidocaine Versus Hydromorphone for Acute Abdominal Pain in the Emergency Department
背景与目的
本研究旨在比较静脉注射利多卡因与氢吗啡酮用于治疗急性腹部疼痛的有效性和安全性。
方 法
本研究为一项随机、双盲、临床试验。在纽约布朗克斯市的2个急症科进行，将体重为60-120Kg的成年腹部疼痛患者随机分配接受静脉推注120mg利多卡因和1mg氢吗啡酮。在给予研究药物首次剂量后30min，询问患者是否需要再次给予麻醉药物进行镇痛。根据肾结石可疑将患者进行进一步分层。主要观察指标为疼痛改善的程度，用疼痛评分进行评估（0-10分）。一个重要的次要观察指标是需要额外的镇痛药，包括类阿片和非甾体类抗炎药。
结 果
本研究一共纳入154名患者，其中，77接受利多卡因进行镇痛，77名接受氢吗啡酮镇痛。90分钟后，利多卡因组的患者疼痛评分（在0到10分的范围内）平均改善了3.8分，而氢吗啡酮组的患者平均改善了5.0分（平均差异1.2；95% CI:0.3-2.2）。77例利多卡因组患者中有39例（51%）和77例氢吗啡酮组患者中有20例（26%）需要额外的镇痛药（差异25%；95% CI:10%-40%）。两组间的不良事件发生无显著性差异。在22例肾结石患者中，利多卡因患者的疼痛程度评分平均改善3.4分，而氢吗啡酮患者的疼痛评分平均改善6.4分（平均差异3.0；95% CI:0.5-5.5)。
结 论
静脉注射氢吗啡酮治疗一般腹痛和肾结石患者均优于利多卡因。
原始文献摘要
Chinn E, Friedman BW, Naeem F, et al. Randomized Trial of Intravenous Lidocaine Versus Hydromorphone for Acute Abdominal Pain in the Emergency Department.[J] .Ann Emerg Med, 2019, 74: 233-240.
Study objective: We compare the effificacy and safety of intravenous lidocaine with that of hydromorphone for the treatment of acute abdominal pain in the emergency department (ED).
Methods: This was a randomized, double-blind, clinical trial conducted in 2 EDs in the Bronx, NY. Adults weighing 60 to 120 kg were randomized to receive 120 mg of intravenous lidocaine or 1 mg of intravenous hydromorphone. Thirty minutes after administration of the fifirst dose of the study drug, participants were asked whether they needed a second dose of the investigational medication to which they were randomized. Patients were also stratifified according to clinical suspicion of
nephrolithiasis. The primary outcome was improvement in pain scores of 0 to 10 between baseline and 90 minutes. An important secondary outcome was need for “off-protocol” parenteral analgesics, including opioids and nonsteroidal anti-inflflammatory drugs.
Results: We enrolled 154 patients, of whom 77 received lidocaine and 77 received hydromorphone. By 90 minutes, patients randomized to lidocaine improved by a mean of 3.8 points on the 0-to-10 scale, whereas those randomized to hydromorphone improved by a mean of 5.0 points (mean difference 1.2; 95% confifidence interval 0.3 to 2.2). Need for off-protocol “rescue” analgesics occurred for 39 of 77 lidocaine patients (51%) and 20 of 77 hydromorphone patients (26%) (difference 25%; 95% confifidence interval 10% to 40%). Adverse events were comparable between groups. Among the subset of 22 patients with nephrolithiasis, lidocaine patients reported a mean improvement of 3.4 points on the pain scale, whereas hydromorphone patients reported a mean improvement of 6.4 points (mean difference 3.0; 95% confifidenceinterval 0.5 to 5.5).
Conclusion: Intravenous hydromorphone was superior to intravenous lidocaine both for general abdominal pain and a subset of patients with nephrolithiasis. A majority of patients randomly allocated to lidocaine required additional analgesics.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
翻译：何幼芹 编辑：何幼芹 审校：王贵龙