Pain Management in Adults With Sickle Cell Disease in a Medical Center Emergency Department
Pain Management in Adults With Sickle Cell Disease in a Medical Center Emergency Department
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DOI：
10.1016/s0027-9684(15)30729-x
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发表时间：
2010-11-01
影响因子：
3.3
通讯作者：
Solomon, Lawrence R.
中科院分区：
文献类型：
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作者：
Solomon, Lawrence R.
d成人镰状细胞病血管闭塞危象患者疼痛管理指南建议及时频繁地给予肠外阿片类药物，以前既没有在忙碌繁忙的城市急诊科实施这些指南的能力，也没有在简单的血管闭塞危象中的剂量要求。因此，2005年在城市医疗中心急诊科治疗的血管闭塞危象的回顾性分析，定义阿片类药物需求和指南实施的障碍19例患者的57次访视是可评价的，在30%的访视期间，阿片类药物治疗的开始时间不超过2小时，在26%的访视中，第一次和第二次阿片类药物给药之间的间隔超过1小时，并且随着后续剂量的增加而增加，在21%的访视期间，总治疗时间小于1小时。访问（中位数22小时），阿片类药物剂量（静脉注射吗啡当量）范围为4至267 mg在40次访视（70%）和10例患者（53%）中，剂量（0 05 050 mg/kg）超过10 mg。此外，在32例家庭出院后的3天内（28%），有9例患者（28%）在前一次就诊期间的治疗时间均小于3小时，因此得出结论：（1）阿片类药物剂量要求差异很大，通常超过指南建议，（2）治疗时间和阿片类药物的及时给药往往会受到影响，导致疼痛控制延迟，过早决定处置，早期回访和可能避免的住院
d Guidelines for pain management in adult sickle cell patients with vaso occlusive crises suggest prompt frequent ad ministration of parenteral opioids Neither the ability to implement these guidelines in a busy urban emergency department nor plod dose requirements in uncomplicated vaso occlusive crisis have been previously documented Thus a retrospective review of vaso occlusive crisis treated in an urban medical center emergency department in 2005 was performed to define opioid requirements and barriers to guideline implementation Fifty seven visits by 19 patients were evaluable Opioid treatment was not initiated for more than 2 hours during 30% of visits the Interval between the first and second opioid doses exceeded 1 hour in 26% of visits and increased with subsequent doses and total treatment time was less than 1 hour during 21% of visits (median 22 hours), Opioid doses (as intravenous morphine equivalents) ranged from 4 to 267 mg (0 05 050 mg/kg) and exceeded 10 mg during 40 visits (70%) and in 10 patients (53%) Hospitalization occurred on 25 occasions with 48% of patients admitted after 3 or fewer pad doses and 50% of patients admitted after less than 3 hours of treatment Moreover return emergency department visits occurred within 3 days after 9 of 32 home discharges (28%) with treatment times uniformly less than 3 hours during the preceding visit It is concluded that (1) opioid dose requirements vary widely often exceeding guideline recommendations and (2) treatment time and timely opioid administration are often compromised resulting in delayed pain control and premature decisions on disposition with early return visits and possibly avoidable hospital admissions