89例急性主动脉夹层患者急诊室早期镇痛情况分析

Analysis of early pain control in 89 patients with acute aortic dissection in emergency room

目的探讨急性主动脉夹层(AAD)患者急诊室早期使用镇痛剂的情况。方法对2013年12月—2014年6月在浙江大学医学院附属第一医院急诊科就诊,临床确诊为AAD的89例患者的临床资料进行回顾性分析,统计AAD以明显疼痛为主要临床表现的发生率,患者入急诊室24h内镇痛药使用率和镇痛药种类,以及入急诊室24~48h仍存在疼痛的发生率。结果 89例患者中以明显疼痛(疼痛VAS评分>3分)为主要临床表现者占84.3%(75/89)。入急诊室24h内,主诉有明显疼痛的患者镇痛药使用率为54.7%(41/75),其中强效镇痛药(包括哌替啶、吗啡和曲马多)的使用率仅为52.0%(39/75)。入急诊室后24~48h仍有53.9%(48/89)的患者疼痛VAS评分>3分。结论对于AAD患者,急诊室早期救治时镇痛剂的使用仍然保守,如何为此类患者提供恰当充分的镇痛有待进一步规范。

Objective To investigate early analgesia in patients with acute aortic dissection （AAD） in the emergency room. Methods Clinical data of 89 patients who were admitted to the department of emergency in our hospital from December 2013 to June 2014 were retrospectively analyzed. Incidence of pain, proportion and types of analgesics used were observed. Results The main clinical manifestation was pain （visual analogue scale [VAS] score〉3） in 75 of 89 patients （84.3%）. Analgesic agents were used in 41 of 75 patients （54.7%） during the early 24 h in the emergency room, and potent analgesics including pethidine, morphine and tramadol were used in 39 patients （52.0%）. Severe pain （VAS score^3） still existed 48 patients （53.9%） 24-48 h after admitted to the emergency room, Conclusion Analgesics is still conservatively used in early-stage treatment in emergency in AAD patients. It is necessary to standardize the analgesia in these patients.