Karmakar Manoj K, Ho Anthony M-H
Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR, People's Republic of China.
J Trauma. 2003 Mar;54(3):615-25. doi: 10.1097/01.TA.0000053197.40145.62.
Multiple rib fracture causes severe pain that can seriously compromise respiratory mechanics and exacerbate underlying lung injury and pre-existing respiratory disease, predisposing to respiratory failure. The cornerstone of management is early institution of effective pain relief, the subject of this review.
A MEDLINE search was conducted for the years 1966 through and up to December 2002 for human studies written in English using the keywords "rib fractures", "analgesia", "blunt chest trauma", "thoracic injury", and "nerve block". The reference list of key articles was also searched for relevant articles. The various analgesic techniques used in patients with multiple fractured ribs were summarized.
Analgesia could be provided using systemic opioids, transcutaneous electrical nerve stimulation or non steroidal anti-inflammatory drugs. Alternatively, regional analgesic techniques such as intercostal nerve block, epidural analgesia, intrathecal opioids, interpleural analgesia and thoracic paravertebral block have been used effectively. Although invasive, in general, regional blocks tend to be more effective than systemic opioids, and produce less systemic side effects.
Based on current evidence it is difficult to recommend a single method that can be safely and effectively used for analgesia in all circumstances in patients with multiple fractured ribs. By understanding the strengths and weaknesses of each analgesic technique, the clinician can weigh the risks and benefits and individualize pain management based on the clinical setting and the extent of trauma.
多根肋骨骨折会引起剧痛，严重影响呼吸力学，加重潜在的肺损伤和原有呼吸系统疾病，易导致呼吸衰竭。有效缓解疼痛的早期干预是治疗的关键，也是本综述的主题。
通过MEDLINE检索1966年至2002年12月间以英文撰写的关于人类研究的文献，关键词为“肋骨骨折”“镇痛”“钝性胸部创伤”“胸部损伤”和“神经阻滞”。还检索了关键文章的参考文献列表以查找相关文章。总结了多根肋骨骨折患者使用的各种镇痛技术。
可使用全身性阿片类药物、经皮电神经刺激或非甾体类抗炎药进行镇痛。此外，肋间神经阻滞、硬膜外镇痛、鞘内注射阿片类药物、胸膜间镇痛和胸段椎旁阻滞等区域镇痛技术也已得到有效应用。尽管具有侵入性，但一般而言，区域阻滞往往比全身性阿片类药物更有效，且产生的全身副作用更少。
基于目前的证据，很难推荐一种能在所有情况下安全有效地用于多根肋骨骨折患者镇痛的单一方法。通过了解每种镇痛技术的优缺点，临床医生可以权衡风险和益处，并根据临床情况和创伤程度进行个体化的疼痛管理。
