Day-care management of sickle cell painful crisis in Jamaica: a model applicable elsewhere?
Day-care management of sickle cell painful crisis in Jamaica: a model applicable elsewhere?
复制标题
DOI：
10.1046/j.1365-2141.1999.01160.x
复制
发表时间：
1999-01-01
影响因子：
6.5
通讯作者：
Serjeant, GR
中科院分区：
文献类型：
--
作者：
Ware, MA;Hambleton, I;Serjeant, GR
在英国和美国，与镰刀细胞相关的入院病例中，80%-90%是痛苦的危机，平均持续时间为5-11d。在牙买加，许多严重的痛苦危机都是在日托中心处理的。在为期一年的研究期间，临床登记了1160例18岁及以上的纯合子镰状细胞(SS)病患者。在这些患者中，216名患者476个痛苦的危象在日托机构总计686d。大多数患者(119名或55.1%)有单一危象，对于大多数危象(338例或71%)，患者只接受1d的卧床休息、保证、补液和止痛。有复杂疼痛危象的患者通常在最初疼痛缓解后转诊入院，其余患者在白天接受监测。在晚上，他们可以选择入院或在家接受口服止痛，42例(8.8%)出现复杂的疼痛危象或止痛药不足而入院，434例(91.2%)发生家庭管理危机。在最初选择家庭管理的186名患者中，20%的患者在随后的住院期间因痛苦的危象而死亡(2.7%)，其中一名患者没有其他已知的并发症，两名患者患有急性胸部综合征(一名患者与沙门氏菌败血症有关)，另一名患者患有沙门氏菌败血症，一名患者患有登革热出血热。在适当的口服止痛、充分的教育和支持下，牙买加SS病的大多数严重痛苦危机都在门诊得到了处理。这种患者护理模式可能值得在其他社区进行评估，在这些社区，痛苦的危机是一个常见的临床问题。
In the U.K. and the U.S.A., painful crises account for 80-90% of sickle-cell-related hospital admissions, with average durations of 5-11 d. In Jamaica, many severe painful crises are managed in a day-care centre. Patients (n=1160) with homozygous sickle cell (SS) disease aged 18 years and over were registered with the clinic during a 1-year study period. Of these, 216 patients with 476 painful crises attended the day-care facility for a total of 686 d. Most patients (119 or 55.1%) had single crises and for most crises (338 or 71%), patients attended for only 1 d, when they were given bed rest, assurance, rehydration and analgesia. Patients with complicated painful crises were usually referred for admission after initial pain relief and the rest were monitored during the day. In the evening they were given the option of hospital admission or allowed home with oral analgesia, Hospital admission for complicated painful crises or inadequate pain relief occurred in 42 (8.8%) crises and home management in 434 (91.2%) crises. Of 186 patients initially selecting home management, 20% returned for further day-care and live (2.7%) died during subsequent admission for that painful crisis, one without other known complications, two with acute chest syndrome (one associated with Salmonella septicaemia), another with Salmonella septicaemia, and one with dengue haemorrhagic fever. With suitable oral analgesia, adequate education and support, the majority of severe painful crises in SS disease in Jamaica have been managed on an outpatient basis. This model of patient care may merit assessment in other communities where painful crises are a common clinical problem.