Safety of prehospital intravenous fentanyl for adult trauma patients.
Safety of prehospital intravenous fentanyl for adult trauma patients.
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成人创伤患者院前静脉注射芬太尼的安全性。
DOI：
10.1097/ta.0b013e31823c4444
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发表时间：
2012
期刊：
影响因子：
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通讯作者：
Colwell,ChristopherB
中科院分区：
文献类型：
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作者：
Soriya,GinaC;McVaney,KevinE;Liao,MichaelM;Haukoos,JasonS;Byyny,RichardL;Gravitz,Craig;Colwell,ChristopherB
背景：对于院前成人创伤患者静脉注射芬太尼的安全性知之甚少。我们的目的是研究院前静脉注射芬太尼对初始血压正常的成人创伤患者的血流动力学影响。方法：采用准实验设计比较大型区域院前系统及其附属一级创伤中心接受静脉注射芬太尼和未接受芬太尼的成人创伤患者。急诊成人创伤患者院前格拉斯哥昏迷评分≥13分，收缩压bbb90 mm Hg。患者分为两组，单剂量静脉注射芬太尼（100 μg）组和未注射芬太尼组。结果是初始急诊科（ED）休克指数（心率除以收缩压）。采用多变量线性回归估计芬太尼对ED休克指数的影响，同时调整院前休克指数、年龄、性别、创伤损伤严重程度评分和接受芬太尼的倾向。结果：纳入763例患者，其中217例（28%）接受芬太尼治疗。两组具有相似的人口统计学特征（年龄、性别和种族/民族），但临床特征不同（ED生命体征、损伤严重程度评分、机制和ED处置）。芬太尼组ED休克调整指数较未服用芬太尼组改善（-0.03,95%可信区间：- 0.05 ~ 0.00,p= 0.02）。结论：院前静脉注射芬太尼对成人创伤患者初始ED休克指数无不良影响。应该进行更多的研究来证实和扩展我们的发现。证据水平：iii。疼痛管理是院前护理的一个重要方面，特别是在急性创伤患者。在所有院前患者中，急性疼痛约占34%至42%。1,2 1999年，紧急医疗服务成果项目确定院前疼痛缓解是一项优先成果，并指出这是可对大多数患者实施的影响最大的院前干预措施之一。芬太尼一直被提倡作为院前镇痛的有效选择，4-8并且在有限的研究中显示芬太尼对院前疼痛管理有效。7,9,10它有许多吸引人的特点，包括起效快、持续时间短、多种给药途径、副作用小和可逆性。然而，像所有阿片类药物一样，芬太尼可能与呼吸抑制和低血压等不良事件有关。不幸的是，仍然缺乏文献评估芬太尼在院前环境的相对安全性。10
BACKGROUND:Little is known about the safety of intravenous fentanyl for adult trauma patients in the prehospital setting. Our objective was to study the hemodynamic effect of prehospital intravenous fentanyl in initially normotensive adult trauma patients.METHODS:A quasi-experimental design was used to compare adult trauma patients who received intravenous fentanyl and those who did not receive fentanyl in a large regional prehospital system and its affiliated Level I trauma center. Emergent adult trauma patients were included with an initial prehospital Glasgow Coma Scale score of≥ 13 and systolic blood pressure> 90 mm Hg. Patients were stratified into two groups, those who received a single dose of intravenous fentanyl (100 μg) and those who did not. The outcome was initial emergency department (ED) shock index (heart rate divided by systolic blood pressure). Multivariable linear regression was used to estimate the effect of fentanyl on ED shock index while adjusting for prehospital shock index, age, gender, Trauma Injury Severity Score, and the propensity for receiving fentanyl.RESULTS:Seven hundred sixty-three patients were included, of whom 217 (28%) received fentanyl. The groups had comparable demographics (age, gender, and race/ethnicity) but different clinical characteristics (ED vital signs, Injury Severity Score, mechanism, and ED disposition). The adjusted ED shock index of fentanyl patients improved (-0.03; 95% confidence interval:− 0.05 to 0.00; p= 0.02) compared with no fentanyl.CONCLUSION:Prehospital intravenous fentanyl did not adversely affect the initial ED shock index in adult trauma patients. Additional research should be performed to confirm and extend our findings.LEVEL OF EVIDENCE:III.Pain management is an important aspect of prehospital care, particularly in the acutely traumatized patient. Acute pain is present in approximately 34% to 42% of all prehospital patients. 1, 2 In 1999, the Emergency Medical Services Outcomes Project identified prehospital pain relief as a priority outcome and noted that it is one of the most high-impact prehospital interventions that can be performed on the majority of patients. 3 Fentanyl has been advocated as an effective option for prehospital analgesia, 4–8 and it has been shown in limited studies to be effective in prehospital pain management. 7, 9, 10 It has many attractive features including rapid onset, short duration, multiple routes of administration, few side effects, and reversibility. However, like all opioids, fentanyl may be associated with adverse events such as respiratory depression and hypotension. Unfortunately, there remains a paucity of literature evaluating the comparative safety of fentanyl in the prehospital setting. 10