急诊科气管插管后抗焦虑和镇痛措施不足。

Inadequate provision of postintubation anxiolysis and analgesia in the ED.

作者信息

Bonomo Jordan B, Butler Andrew S, Lindsell Christopher J, Venkat Arvind

机构信息

Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH 45267-0769, USA.

出版信息

Am J Emerg Med. 2008 May;26(4):469-72. doi: 10.1016/j.ajem.2007.05.024.

DOI:10.1016/j.ajem.2007.05.024

PMID:18410818

Abstract

INTRODUCTION

Patients intubated in the emergency department (ED) often have extended ED stays. We hypothesize that ED intubated patients receive inadequate postintubation anxiolysis and analgesia after rapid sequence induction (RSI).

METHODS

This was a retrospective cohort study of every adult intubated in a tertiary-care ED (July 2003-June 2004). Patients were included if they underwent RSI, remained in the ED for more than 30 minutes post intubation, and survived to admission. Presuming a mean patient weight of 70 kg, we defined adequacy of anxiolysis and analgesia on the provision postintubation of weight-based doses of lorazepam (0.77 mg/h) or midazolam (4.2 mg/h) and fentanyl (35 microg/h), referenced from pharmaceutical texts. Demographic data, time in ED, and dosage of each medication given were abstracted. The proportion, with 95% confidence intervals (CIs), of patients receiving inadequate anxiolysis and analgesia were computed.

RESULTS

One hundred seventeen patients met the inclusion criteria. Mean time in the ED was 4.2 hours (SD +/- 3.1 hours). Thirty-nine patients received no anxiolytic (33%, CI 25%-43%), and 62 received no analgesic (53%, CI 44%-62%). Twenty-three patients received neither anxiolytic nor analgesic (20%, CI 13%-28%). Of 70 patients given postintubation vecuronium, 67 received either no or inadequate anxiolysis or analgesia (96%, CI 87%-99%). Overall, 87 of 117 patients received no or inadequate anxiolysis (74%, CI 65%-82%); and 88 of 117 received no or inadequate analgesia (75%, CI 66%-83%).

CONCLUSION

Patients undergoing RSI in the ED frequently receive inadequate postintubation anxiolysis and analgesia.

摘要

引言

在急诊科（ED）接受气管插管的患者往往在急诊科停留时间延长。我们假设，急诊科接受气管插管的患者在快速顺序诱导（RSI）后，插管后的抗焦虑和镇痛措施不足。

方法

这是一项对三级医疗急诊科（2003年7月至2004年6月）所有成年插管患者的回顾性队列研究。纳入标准为接受RSI、插管后在急诊科停留超过30分钟且存活至入院的患者。假设患者平均体重为70kg，我们根据药学文献，通过插管后给予基于体重的劳拉西泮（0.77mg/h）或咪达唑仑（4.2mg/h）及芬太尼（35μg/h）的剂量来定义抗焦虑和镇痛是否充分。提取人口统计学数据、在急诊科的时间以及每种药物的给药剂量。计算接受抗焦虑和镇痛不足的患者比例及其95%置信区间（CI）。

结果

117例患者符合纳入标准。在急诊科的平均停留时间为4.2小时（标准差±3.1小时）。39例患者未接受抗焦虑药物治疗（33%，CI 25%-43%），62例未接受镇痛药物治疗（53%，CI 44%-62%）。23例患者既未接受抗焦虑药物也未接受镇痛药物治疗（20%，CI 13%-28%）。在70例插管后给予维库溴铵的患者中，67例未接受或接受的抗焦虑或镇痛措施不足（96%，CI 87%-99%）。总体而言，117例患者中有87例未接受或接受的抗焦虑措施不足（74%，CI 65%-82%）；117例中有88例未接受或接受的镇痛措施不足（75%，CI 66%-83%）。