吸入氧化亚氮在院前创伤急救中的镇痛作用  

Safety and analgesia of inhaling a mixture of nitrous oxide and oxygen in prehospital patients with traumatic pain

作　　者：陶庭俊 李佳宇 卢魁[4] 陈石生[4] 符培栋 刘法清 申朝霞[4] 刘文玉[4] 林淑文[4] 孔艳霞[4] 齐向东[1,2] 

机构地区：[1]南方医科大学,广州510515 [2]广州军区广州总医院整形科,广州510010 [3]广东省水电医院骨科,广州511340 [4]南方医科大学第三附属医院急诊科,广州510630

出　　处：《中华急诊医学杂志》2017年第2期239-243,共5页Chinese Journal of Emergency Medicine

摘　　要：目的探讨氧化亚氮吸入镇痛系统在创伤患者院前急救中的安全性和有效性。方法选取2014年10月至2016年4月南方医科大学第三附属医院急诊科院前急救的106例四肢创伤患者。计算机随机法将患者分为试验组（T）和对照组？，每组53例。每例经氧化亚氮吸入镇痛系统吸入气体，T组吸入氧化亚氮和氧气的混合气体（50：50），C组吸入氧气，其余治疗相同。记录不同时间点呼吸频率（RR）、心率（HR）、血压（BP）、脉搏血氧饱和度（SpO2）和视觉模拟疼痛评分（VAS），以及不良反应。单因素方差分析和t检验进行统计学处理。结果与吸气前比较，T组吸气后10，15，30，45minRR和HR明显降低（P〈0．05或〈0．01），C组吸气后15，30，45minRR明显降低（P〈0．05或〈0．01）而HR变化不大。不同时间点RR、HR、BP和SpO2两组间差异无统计学意义。吸气前VAS评分两组差异无统计学意义（P=0．678），T组吸气15min后VAS评分降到（2．94±1．03）分（P〈0．01），c组VAS评分轻度下降但大于6分。T组15例（28．3％）出现头晕，13例（24．53％）出现恶心，8例（15．09％）出现呕吐，3例（5．66％）出现意识轻度下降。没有一例出现呼吸抑制、低氧血症和低血压。结论氧化亚氮吸入镇痛系统可以有效地减轻院前创伤患者疼痛且安全，不良反应低。Objective To evaluate the safety and analgesia efficacy of inhalation of a blended 50/50 mixture of nitrous oxide and oxygen for relieving pain in limb traumatized patients in pre-hospital setting. Methods A total of 106 traumatic patients treated with painkiller of nitrous oxide and oxygen mixture in pre-hospital setting admitted in the emergency department from October 2014 to April 2016 were enrolled. They were divided into control group （n = 53, inhalation of oxygen） and treatment group （n = 53, treated with inhalation of a mixture of 50% nitrous oxide and oxygen） according to the computer-generated list of random number. The same routine treatment was given to patients of both groups. Respiratory rate （RR）, heart rate （ HR）, blood pressure （ BP）, pulse oxygen saturation of oximetry （ SpO2 ） measured at different intervals during the entire course of inhalation and adverse effects were recorded. The degree of pain was evaluated with the visual analogue scale （VAS）. Results There were no significant differences between control group and treatment group in RR, HR, BP, and SpO2 before and 5, 10, 15, 30, 45 min after inhalation. Compared with RR and HR before inhalation, RR and HR were significantly decreased 10, 15, 30, 45 min after inhalation （ P 〈0. 05 or 〈0. 01） in treatment group. The RR was decreased 15, 30, 45 min after inhalation （P 〈 0. 05 or 〈 0. 01 ）, but there was no statistically significant change in HR in control group. There were no differences in the VAS scores before inhalation between two groups （P = 0. 678 ） butthe difference after inhalation were statistically significant （P 〈0. 01 ） . The VAS scores after inhalation for 15 min in treatment group lowered to below 3, in an average of （2. 94 ± 1.03 ） （ P 〈 0. 01 ）. The VAS scores in control group were slightly lowered to above than 6 at all intervals after inhalation. There were some minor side effects consisting of dizziness （ 28. 3% ）, nausea （ 24. 53% ）, vomiting （ 15

关 键 词：院前 创伤 吸入 氧化亚氮 氧气 镇痛 安全 有效 

分 类 号：R641[医药卫生—外科学]