【罂粟摘要】美沙酮与吗啡用于妇科肿瘤手术患者术后镇痛的比较:一项随机对照研究
美沙酮与吗啡用于妇科肿瘤手术患者术后镇痛的比较:一项随机对照研究
贵州医科大学 高鸿教授课题组
翻译：唐剑 编辑：佟睿 审校：曹莹
本研究的目的主要是是比较美沙酮和吗啡对患者术后疼痛治疗效果的影响。
研究对象为大于18岁、ASA I–III级未孕女性、拟在全麻下因妇科肿瘤进行子宫输卵管切除术的患者。将60名患者随机分为吗啡组或美沙酮组。术前给予吗啡或美沙酮0.15 mg/kg。术后开始静脉注射吗啡或美沙酮，剂量为12 mg/d。患者入室后静注咪达唑仑0.1 mg/kg，美沙酮或吗啡0.15 mg/kg。术中按需使用芬太尼镇痛。在PACU中，如疼痛评分≥4，给予3 mg美沙酮（吗啡组给与相同剂量吗啡）。离开PACU时，给予美沙酮12 mg。主要观察指标为手术当日和术后第1天不同时间的疼痛强度。次要观察指标包括疼痛强度差值（PID）、48小时后时间加权疼痛强度差值(SPID 48)，以及阿片类药物使用总量。
美沙酮组患者术后第2天的镇痛效果优于吗啡组，且美沙酮组患者阿片类药物使用量显著降低，未出现血氧饱和度降低或呼吸抑制等相关并发症。
与吗啡相比，术前及术后持续低剂量输注美沙酮镇痛效果更好，且相关并发症发生率较低。
原始文献来源：
Mercadante Sebastiano,David Fabrizio,Villari Patrizia et al. Methadone versus morphine for postoperative pain in patients undergoing surgery for gynecological cancer: A randomized controlled clinical trial.[J] .J Clin Anesth, 2020, 61: 109627.
Methadone versus morphine for postoperative pain in patients undergoing surgery for gynecological cancer: A randomized controlled clinical trial.
STUDY OBJECTIVE:The aim of this study was to compare methadone and morphine for the management of postoperative.
DESIGN:Open, controlled study.
SETTING:Postoperative recovering area, ward.
PATIENTS:Sixty-four patients, ASA I-III, undergoing gynecological surgery for cancer.
INTERVENTIONS:Morphine or methadone 0.15 mg/kg given preoperatively. After operation an intravenous morphine or intravenous methadone infusion at doses of 12 mg/day was started.
MEASUREMENTS:Pain intensity and opioid consumption.
MAIN RESULTS:Methadone infusion provided a better analgesia in comparison with morphine infusion on the second day. Opioid consumption was significantly lower in the methadone group. No episodes of relevant desaturation or signs of respiratory depression were recorded.
CONCLUSION:A preoperative bolus of methadone, followed by a continuous infusion of low doses post-operatively, provided a better analgesia, without adding risk of adverse effects, in comparison with morphine.
注：根据译者习惯，可能与原文结构并不相同，但内容一致。