单针法腰骶丛联合阻滞模拟战现场急救中对下肢创伤伤员的镇痛效果  

Analgesic effect of single-acupuncture lumbosacral plexus block in simulated field emergency care for trauma patients with lower limb injuries

作　　者：贾云逸 高成杰 刘晓翔 唐文红 Jia Yunyi;Gao Chengjie;Liu Xiaoxiang;Tang Wenhong(School of Anesthesia,Shandong Second Medical University,Weifang,Shandong Province 261021,China;Department of Anesthesiology,No.960 Hospital of PLA Joint Logistic Support Force,Jinan 250031,China)

机构地区：[1]山东第二医科大学麻醉学院,山东潍坊261021 [2]联勤保障部队第九六〇医院麻醉科,济南250031

出　　处：《创伤外科杂志》2024年第12期885-891,共7页Journal of Traumatic Surgery

基　　金：军队后勤重点科研项目。

摘　　要：目的评估单针法腰骶丛联合阻滞在跟随120救护车现场急救中对下肢创伤伤员镇痛的疗效,模拟其用于战现场的可行性及有效性,为提升战现场一线救治能力提供参考。方法前瞻性选择2023年6月—2023年11月联勤保障部队第九六〇医院120急救中心现场收治模拟战时受伤的下肢创伤伤员50例,男性29例,女性21例;年龄20~60岁,平均45.7岁;平均BMI(23.54±2.86)kg/m^(2);ASA分级:Ⅰ级36例,Ⅱ级14例。采用随机数字表法分为观察组和对照组,各25例。到达创伤现场后,观察组于手持式便携超声引导下使用0.25%盐酸罗哌卡因进行单针法腰骶丛联合阻滞,对照组肌肉注射盐酸吗啡10 mg,操作均由同1名随行麻醉师完成。比较两组伤员镇痛即刻(T_(0))、转运途中5 min(T_(1))、转运途中15 min(T_(2))、入院即刻(T_(3))、入手术室时(T_(4))的镇痛效果、血流动力学水平。比较两组伤员的镇痛操作时间、镇痛起效时间、对镇痛效果的满意度评分及不良反应,比较两组伤员伤后7 d、3个月的创伤后应激障碍(PTSD)评分及慢性疼痛发生率。结果T_(1)、T_(2)、T_(3)、T_(4)时点,观察组静息疼痛数字评分(NRS)均低于对照组[(4.1±1.3)分vs.(6.3±1.2)分、(2.7±1.2)分vs.(5.0±0.9)分、(1.7±0.9)分vs.(3.8±1.0)分、(1.2±0.7)分vs.(2.9±0.8)分,P<0.05],观察组运动NRS均低于对照组[(5.4±1.6)分vs.(7.8±1.2)分、(3.9±1.4)分vs.(6.5±1.0)分、(2.8±1.1)分vs.(5.4±1.1)分、(2.2±1.0)分vs.(4.6±1.0)分,P<0.05];T_(1)、T_(2)、T_(3)、T_(4)时点,观察组MAP[(99.4±7.6)mmHg、(95.4±6.1)mmHg、(94.2±6.2)mmHg、(94.6±5.4)mmHg]较对照组[(106.4±8.2)mmHg、(90.2±7.6)mmHg、(88.3±7.6)mmHg、(88.4±7.8)mmHg]更平稳,差异有统计学意义(P<0.05);相比对照组,观察组镇痛操作时间长、起效时间快[(6.1±0.8)min vs.(1.7±0.7)min,(5.9±1.0)min vs.(10.5±1.4)min],差异有统计学意义(P<0.05);两组HR、SpO 2在各时间点比较差异均无统计学意义(P>0.05);观�Objective To evaluate the analgesic effect of single-acupuncture lumbosacral plexus block during the 120-ambulance first aid on site fortrauma patients with lowerlimb injuries,and to evaluate the feasibility and effectiveness in simulated battlefield.Methods From Jun.2023 to Nov.2023,the 120-ambulance centerof No.960 Hospital of PLA Joint Logistics Support Force managed 50 cases of lowerlimb injuries on site,including 29 males and 21 females aged 20-60(mean 45.7)years.The average body mass index wasZ(23.54±2.86)kg/m^(2);the American Society of Anesthesiologists classification showed 36 cases of gradeⅠand 14 of gradeⅡ.One anesthetist was enrolled in the rescue team to stimulate battlefield emergency rescue and conduct all the analgesic treatments.Patients were divided into control group orobservation group according to the random numbertable method,with 25 cases in each group.Afterarriving at the trauma scene,patients in the observation group received ultrasound-guided(handheld)single-acupuncture lumbarplexus block with 0.25%ropivacaine,while those in the control group were intramuscularly injected with 10 mg morphine hydrochloride.The analgesic effect assessed by the numerical rating scale(NrS)and hemodynamic status were monitored at 5 time points:immediately afteranalgesia(T_(0)),5 min during pre-hospital transportation(T_(1)),15 min during pre-hospital transportation(T_(2)),on admission(T_(3)),and entrance of the operating room(T_(4)).The operation time and onset time foranalgesic treatment,adverse reactions,and satisfaction scores from patients were compared between the two groups,as well as the post-traumatic stress disorderscale-5th edition(PCL-5)scores at 7 d and 3 months afterinjury and the incidence of chronic pain.Results At T_(1),T_(2),T_(3),T_(4),the NrS at resting state was much lowerin the observation group than in the control group(4.1±1.3 vs.6.3±1.2,2.7±1.2 vs.5.0±0.9,1.7±0.9 vs.3.8±1.0,1.2±0.7 vs.2.9±0.8,all P<0.05),moreover,the NrS at movement status was also much lowerin the observa

关 键 词：下肢创伤 疼痛管理 院前处置 

分 类 号：R614[医药卫生—麻醉学]