预镇痛对严重多发伤患者疼痛和炎症的作用评价  

Effect of pre-emptive analgesia on pain and inflammation control in severe multiple trauma patients

作　　者：陈聪[1] 曾凡杰[1] 苟亚军[1] 陈翔宇[1] 郭国宁[1] 张雷[1] 刘明华[1] 

机构地区：[1]第三军医大学西南医院急救部创伤救治中心,重庆400038

出　　处：《中华创伤杂志》2016年第8期735-740,共6页Chinese Journal of Trauma

基　　金：第三军医大学临床创新基金（WX2014-002）

摘　　要：目的探讨预镇痛对严重多发伤患者的镇痛效果及其对应激炎症反应的调控作用。方法前瞻性研究2014年9月-2014年12月收治的多发伤患者，损伤严重度评分（ISS）16～25分，格拉斯哥昏迷评分（GCS）≥13分，视觉模拟评分（VAS）≥4分，按随机数字表法分为预镇痛组、传统镇痛组和无镇痛组。预镇痛组在入院时即予舒芬太尼联合曲马多经静脉患者自控镇痛（PCIA）。传统镇痛组在患者疼痛难以忍受时临时予肌注杜冷丁或皮下注射吗啡。无镇痛组暂不予镇痛，当无法忍受疼痛时，予镇痛后排除出组。比较三组入院时及入院后24，48，72，120，168，240h视觉模拟评分（VAS）、全身炎症反应综合征（SIRS）评分及血清白细胞介素-6（IL-6）浓度变化。结果共纳入57例患者，其中男46例，女11例；年龄（39．61±12．05）岁。预镇痛组18例，传统镇痛组20例，无镇痛组19例。入院时预镇痛组、传统镇痛组与无镇痛组VAS分别为（6．5±1．5）分、（6．6±1．4）分、（6．4±1．4）分，SIRS评分别为（3．3±0．7）分、（3．4±0．6）分、（3．4±0．8）分，IL-6浓度分别为（109．2±47．9）ng／L、（99．9±44．3）ng／L、（106．3±50．0）ng／L，差异均无统计学意义（P〉0．05）。但预镇痛组与其余两组比较，VAS与SIRS评分在入院后24，48，72，120，168，240h差异均有统计学意义（P〈0．05）；IL-6浓度在入院后48，72，120，168，240h差异有统计学意义（P〈0．05）。预镇痛组VAS、SIRS评分及IL-6的下降速度较其余两组更明显（P〈0．05），而传统镇痛组与无镇痛组间差异无统计学意义（P〉0．05）。三组VAS与SIRS评分和IL-6呈正相关性（P〈0．05）。结论对于严重多发伤患者，预镇痛可以快速有效缓解疼痛，并在一定程度上减轻多发伤后过度的全身炎症反应，有助于病情的稳定和恢复。Objective To evaluate the effect of pre-emptive analgesia on pain and inflammation control in patients with severe multiple trauma. Methods Severe multiple trauma patients treated in the emergency department from September 2014 to December 2014 were prospectively included based on the inclusion criteria including injury severity score （ISS） of 16 to 25, Glasgow Coma Scale （GCS） t〉 13 and visual analogue scale （VAS） ≥ 4. The patients were assigned to pre-emptive analgesia group, traditional analgesia group and non-analgesia group, according to the random number table. Pre-emptive analgesia group had patient-controlled intravenous analgesia （PCIA） with sufentanil and tramadol on admission. Traditional analgesia group were administered intramuscular pethidine or subcutaneous morphine for temporary analgesia when the pain could not be tolerated. Non-analgesia group received no analgesia. VAS, systemic inflammatory response syndrome （SIRS） score and serum interleukin （IL）-6 concentration were compared among the groups on admission day, 24, 48, 72, 120, 168 and 240 h after admission. Results Fifty-seven patients （46 males and 11 females） were included, and age was （39.61 ± 12.05 ）years. There were 18 patients in pre-emptive analgesia group, 20 patients in traditional analgesia group, and 19 patients in non-analgesia group. Comparison between pre-emptive analgesia, traditional analgesia and non-analgesia groups showed no significant differences on admission with respect toVAS [ （6.5±1.5）, （6.6±1.4）, （6.4±1.4）points], SIRS [（3.3±0.7）, （3.4 ±0.6）, （3.4± 0.8）points] and IL-6 concentration [（109.2 ±47.9）, （99.9 ±44.3）, （106.3 ± 50. 0） ng/L] （P〉 0. 05）. Compared to traditional analgesia and non-analgesia groups, VAS and SIRS score in pre-emptive analgesia group differed significantly at 24, 48, 72, 120, 168 and 240 h after admission, and IL-6 in pre-emptive analgesia group differed significantly at 48, 72, 120, 168 and 240 h after admissi

关 键 词：镇痛 多处多发伤 炎症 

分 类 号：R641[医药卫生—外科学]