目的 评价重症急性左心衰竭患者机械通气时采用咪达唑仑与吗啡联合持续镇静的效果。 方法 选择2007年4月－2010年4月在重症医学科（ICU）进行有创机械通气的重症急性左心衰竭患者86例，随机均分为咪达唑仑组（A组）、咪达唑仑联合吗啡组（B组）。采用Ramsay镇静评分，使每例患者镇静水平达RamsayⅢ～Ⅳ级。观察起效时间、镇静时间、停药后苏醒时间和停药后拔管时间；监测镇静12 h后的血气分析及血流动力学参数的变化。 结果 B组起效时间、镇静时间、停药后苏醒时间和停药后拔管时间明显短于A组（P＜0.05）。且镇静12 h后B组血气分析及血流动力学较A组明显改善（P＜0.05）。 结论 重症急性左心衰竭患者机械通气时使用咪达唑仑联合吗啡镇静能达到满意镇静效果，同时改善重症急性左心衰竭患者的低氧血症和高碳酸血症。
ObjectiveTo systematically review the efficacy of transdermal fentanyl versus oral morphine for moderate/severe cancer pain. MethodsDatabases such as The Cochrane Library (Issue 1, 2014), PubMed, Web of Science, CNKI, VIP, CBM and WanFang Data were searched for randomized controlled trials (RCTs) on the efficacy of transdermal fentanyl versus oral morphine for moderate/severe cancer pain up to January 2014. According to inclusion and exclusion criteria, two reviewers independently screened literature, extracted data, and assessed methodological quality of included studies. Then meta-analysis was performed using RevMan 5.1.0 software. ResultsA total of 35 RCTs involved 3 406 patients were included. The results of meta-analysis showed that, there was no significant difference in effectiveness between transdermal fentanyl and oral morphine for moderate/severe cancer pain (OR=1.00, 95%CI 0.80 to 1.27, P=0.99). Compared with oral morphine, transdermal fentanyl was better in lowering the incidences of constipation, nausea and vomiting, lethargy and urinary retention; but transdermal fentanyl increased the incidences of skin rashes and itch (P < 0.05). ConclusionTransdermal fentanyl is as effective as oral morphine in the treatment of moderate/severe cancer pain, and transdermal fentanyl causes less side effects. Due to poor quality of the included studies, the above conclusion should be verified by further conducting more high quality RCTs.
ObjectiveTo systematically review the efficacy and safety of oxycodone versus morphine for postoperative intravenous self-control analgesia (PCIA). MethodsWe searched databases including PubMed, EMbase, The Cochrane Library (Issue 8, 2015), CBM, CNKI, VIP, WanFang Data from inception to August 2015, to collect randomized controlled trials (RCTs) about oxycodone versus morphine for postoperative PCIA. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software.ResultsSeven RCTs involving 826 patients were included. The results of meta-analysis showed that: there were no significant differences in postoperative analgesia at the points of 2 h, 3 h, 4 h, 8 h, 12 h, 24 h, 36 h and 48 h after surgery (2 h: MD=0.20, 95%CI –0.18 to 0.58, P=0.30; 3 hresting state: MD=–0.51, 95%CI –2.27 to 1.26, P=0.57; 3 hdynamic state: MD=–0.46, 95%CI –2.23 to 1.40, P=0.63; 4 h: MD=0.00, 95%CI –0.25 to 0.25, P=0.99; 8 h: MD=0.10, 95%CI –0.16 to 0.36, P=0.46; 12 h: MD=–0.34, 95%CI –0.85 to 0.17, P=0.19; 24 h: MD=–0.13, 95%CI –0.43 to 0.17, P=0.41; 36 h: MD=0.10, 95%CI –0.28 to 0.48, P=0.60; 48 h: MD=–0.13, 95%CI –0.36 to 0.09, P=0.25). The incidences of postoperative vomiting (OR=0.23, 95%CI 0.08 to 0.63, P=0.005), nausea (OR=0.27, 95%CI 0.08 to 0.86, P=0.03), respiratory depression (OR=0.15, 95%CI 0.04 to 0.53, P=0.003) and skin pruritus (OR=0.19, 95%CI 0.05 to 0.66, P=0.009) in the oxycodone group were lower than those in the morphine group. In addition, there were no significant differences of the incidences of headache, dizzy and shiver between two groups.ConclusionCompared with morphine, oxycodone has the same analgesia effect for PCIA, however, the incidences of adverse reactions are lower. Due to the limited quality and quantity of included studies, the above results are needed to be validated by more high quality studies.
ObjectivesTo systematically review the efficacy and safety of hydromorphone and morphine in post-cesarean section analgesia.MethodsThe Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMbase, CNKI, WanFang Data, VIP and SinoMed databases were electronically searched to identify randomized controlled trials (RCTs) of hydromorphone vs. morphine in the treatment of postoperative analgesia after cesarean section from the inception of the database to December 2017. Two reviewers independently screened literatures, extracted data and assessed risk of bias of the included trials. The meta-analysis was conducted with RevMan 5.3 software.ResultsSeven trials with 586 post-cesarean section patients were included. The results of the meta-analysis showed that, compared with the morphine group, the hydromorphone group had lower 6 h (MD=–0.23, 95%CI –0.38 to –0.08, P=0.003), 12 h (MD=–0.56, 95%CI –1.10 to –0.02, P=0.04), 24 h (MD=–0.37, 95%CI –0.65 to –0.09, P=0.01) and 48 h (MD=–0.41, 95%CI –0.74 to –0.08, P=0.01) postoperative VAS scores the with epidural anesthesia pump (PECA). There was no statistically significant difference of the postoperative Ramsay scores between the two groups. In terms of side effects, the incidence of skin pruritus (RR=0.27, 95%CI 0.09 to 0.81. P=0.02) and vomit (RR=0.15, 95%CI 0.03 to 0.65, P=0.01) of the hydromorphone group were lower than those of the morphine group.ConclusionsThe current evidence demonstrate that, compared with morphine, hydromorphone has better postoperative analgesia performance and less risk of exhibiting skin pruritus and vomit after cesarean section. Considering of the overall quality of evidence and the relatively small pooled sample size, more well-conducted randomized controlled trials are required to verify the above conclusion.
ObjectiveTo analyze the effect of mitochondrial ultrastructural changes caused by morphine toxicity on abnormal discharge of cat cerebral cortex, and to explore the possible mechanism of brain function damage caused by morphine dependence.MethodsTwelve domestic cats were divided into control group (3 cats) and morphine exposed group (9 cats) according to the method of random number table. After the model was successfully established by the method of dose increasing, the changes of mitochondrial ultrastructure of cortical neurons were observed under the electron microscope.ResultsElectroencephalogram (EEG) monitoring in morphine exposed group showed that the cortical EEG was widely abnormal, physiological waves were reduced, and abnormal discharges were frequent. And the electron microscopy showed that the number, morphology, internal membrane structure and the inclusion body in the matrix of neurons changed in various aspects. The EEG and electron microscopy of the control group were normal.ConclusionMorphine can damage neurons in the cerebral cortex and lead to abnormal discharge, which is closely related to the ultrastructural changes of neuron mitochondria. The toxicity of morphine mitochondria can be the initial mechanism of energy metabolism dysfunction of brain cells and eventually lead to the disorder of brain electrophysiological function.
Objective To investigate the current status of constipation during postoperative hospitalization and the factors associated with moderate to severe constipation at discharge in lung cancer patients. Methods Lung cancer patients who underwent surgery in 6 tertiary hospitals in Sichuan Province from November 2017 to January 2020 were enrolled. The MD Anderson Symptom Scale-Lung Cancer Module was used to collect postoperative constipation scores. Unconditional logistic stepwise regression was used to analyze the related influencing factors for moderate to severe constipation on the day of discharge. Results Finally 337 patients were collected. There were 171 males and 166 females, with an average age of 55.0±10.3 years. Constipation scores of lung cancer patients increased from postoperative day 1 to day 3, and showed a decreasing trend from day 3 to day 7. Moderate to severe constipation was present in 68 (20.2%) patients at discharge. The postoperative hospital stay (OR=0.743, P<0.001) and the dose of morphine used during postoperative hospitalization (OR=1.002, P=0.015) were influencing factors for moderate to severe constipation at discharge in lung cancer patients. ConclusionLung cancer patients have the most severe constipation on postoperative day 3. Moderate to severe constipation at discharge is associated with the postoperative hospital stay and the dose of morphine used during postoperative hospitalization.