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首页> 外文期刊>Radiology >Acute appendicitis: influence of early pain relief on the accuracy of clinical and US findings in the decision to operate--a randomized trial.
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Acute appendicitis: influence of early pain relief on the accuracy of clinical and US findings in the decision to operate--a randomized trial.

机译：急性阑尾炎：早期疼痛缓解对手术决策中临床和美国研究结果准确性的影响-一项随机试验。

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PURPOSE: To determine the influence of early pain relief on the diagnostic performance of ultrasonography (US) and on the appropriateness of the surgical decision. MATERIALS AND METHODS: A prospective randomized, double-blind placebo-controlled trial with morphine was conducted. A visual analog scale was used to evaluate pain in 340 patients aged 16 years or older. US was performed with a standardized protocol. Diagnosis was confirmed at histologic analysis or, in the patients released without surgery, at follow-up. RESULTS: One hundred seventy-five patients were injected with morphine, and 165 were injected with the placebo. Pain relief was stronger in the morphine group. In the morphine group, US had lower (71.1%) sensitivity (difference, -9.5%; 95% CI, -18.5%, -0.5%) and higher (65.2%) specificity (difference, 11.4%; 95% CI, 1.0%, 21.8%). This group had also a higher positive predictive value (64.6%) and a lower negative predictive value (71.4%), but the differences between this group and the placebo group were not statistically significant. Among female patients, the decision to operate was appropriate more often in the morphine group (75.8%), but the difference between this group and the placebo group was not statistically significant (5.1%; 95% CI, -7.4%, 17.6%). In male patients and overall, opiate analgesia did not influence the appropriateness of the decision. The appropriateness to discharge patients without surgery was 100% in all groups. CONCLUSION: Morphine does not improve US-based diagnosis of appendicitis.
机译：目的：确定早期疼痛缓解对超声（US）的诊断性能和手术决策的适当性的影响。材料与方法：进行了一项前瞻性随机，双盲，安慰剂对照的吗啡试验。视觉模拟量表用于评估340位16岁或16岁以上患者的疼痛。 US是使用标准化协议执行的。在组织学分析中或在未手术的情况下进行随访的患者中确诊。结果：175例患者接受了吗啡注射，165例接受了安慰剂注射。吗啡组的疼痛缓解作用更强。吗啡组的US敏感性较低（差异为-9.5％，-9.5％; 95％CI，-18.5％，-0.5％），特异性较高（65.2％）（差异为11.4％; 95％CI为1.0 ％，21.8％）。该组的阳性预测值也较高（64.6％），阴性预测值较低（71.4％），但该组与安慰剂组之间的差异无统计学意义。在女性患者中，吗啡组（75.8％）的手术决策更为合适，但该组与安慰剂组之间的差异无统计学意义（5.1％; 95％CI，-7.4％，17.6％） 。对于男性患者和总体而言，阿片类镇痛不会影响该决定的适当性。所有组中无手术出院的适宜性均为100％。结论：吗啡不能改善基于美国的阑尾炎的诊断。

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