Melzer-Lange Marlene D, Walsh-Kelly Christine M, Lea Gwen, Hillery Cheryl A, Scott J Paul
Department of Pediatrics, Children's Hospital of Wisconsin, Milwaukee, WI 53226, USA.
Pediatr Emerg Care. 2004 Jan;20(1):2-4. doi: 10.1097/01.pec.0000106235.72265.29.
To determine whether a protocol to start patient-controlled analgesia (PCA) in the emergency department (ED-PCA) would shorten the length of time between narcotic bolus doses and PCA initiation as compared with standard inpatient initiation of PCA (IP-PCA). Also, to compare patient satisfaction and inpatient length of stay for the 2 groups.
To improve care, we developed a protocol to institute ED-PCA after an initial bolus dose of narcotics. This was a nonrandomized pilot study. Patient records were reviewed for location of PCA initiation, time from narcotic bolus to initiation of PCA, and length of stay. A brief patient/parent satisfaction survey was collected.
Sixty-nine records were reviewed. Patients treated using the protocol had initiation of PCA therapy within 35 +/- 7 minutes from the last bolus narcotic dose in the emergency department versus 211 +/- 17 minutes for nonprotocol patients. Forty-eight of 50 patient surveys indicated preference for starting ED-PCA; 2 did not have a preference. No complications were identified in either group.
A protocol to initiate PCA for sickle cell patients in a pediatric emergency department shortened the time of its initiation and was preferred by patients.
确定在急诊科启动患者自控镇痛（ED-PCA）的方案与标准住院患者启动PCA（IP-PCA）相比，是否会缩短麻醉推注剂量与启动PCA之间的时间间隔。同时，比较两组患者的满意度及住院时间。
为改善护理，我们制定了一项在首次给予麻醉推注剂量后启动ED-PCA的方案。这是一项非随机的试点研究。回顾患者记录，以了解PCA启动的地点、从麻醉推注到启动PCA的时间以及住院时间。收集了一份简短的患者/家长满意度调查问卷。
共回顾了69份记录。采用该方案治疗的患者在急诊科最后一次推注麻醉剂量后35±7分钟内启动了PCA治疗，而非方案治疗的患者为211±17分钟。50份患者调查问卷中有48份表示倾向于启动ED-PCA；2份没有偏好。两组均未发现并发症。
在儿科急诊科为镰状细胞病患者启动PCA的方案缩短了启动时间，且受到患者青睐。
