Naval Health Research Center, San Diego, CA 92106-3521, USA.
N Engl J Med. 2010 Jan 14;362(2):110-7. doi: 10.1056/NEJMoa0903326.
Post-traumatic stress disorder (PTSD) is a common adverse mental health outcome among seriously injured civilians and military personnel who are survivors of trauma. Pharmacotherapy in the aftermath of serious physical injury or exposure to traumatic events may be effective for the secondary prevention of PTSD.
We identified 696 injured U.S. military personnel without serious traumatic brain injury from the Navy-Marine Corps Combat Trauma Registry Expeditionary Medical Encounter Database. Complete data on medications administered were available for all personnel selected. The diagnosis of PTSD was obtained from the Career History Archival Medical and Personnel System and verified in a review of medical records.
Among the 696 patients studied, 243 received a diagnosis of PTSD and 453 did not. The use of morphine during early resuscitation and trauma care was significantly associated with a lower risk of PTSD after injury. Among the patients in whom PTSD developed, 61% received morphine; among those in whom PTSD did not develop, 76% received morphine (odds ratio, 0.47; P<0.001). This association remained significant after adjustment for injury severity, age, mechanism of injury, status with respect to amputation, and selected injury-related clinical factors.
Our findings suggest that the use of morphine during trauma care may reduce the risk of subsequent development of PTSD after serious injury.
创伤后应激障碍（PTSD）是严重受伤的平民和创伤幸存者的常见不良心理健康后果。在严重身体受伤或暴露于创伤性事件后进行药物治疗可能对 PTSD 的二级预防有效。
我们从海军陆战队战斗创伤登记处远征医疗遭遇数据库中确定了 696 名没有严重创伤性脑损伤的美国受伤军人。为所有选定人员提供了关于所给予药物的完整数据。 PTSD 的诊断来自职业历史档案医疗和人员系统，并在审查病历中得到证实。
在所研究的 696 名患者中，有 243 名被诊断为 PTSD，453 名未被诊断为 PTSD。早期复苏和创伤护理中使用吗啡与受伤后 PTSD 的风险降低显著相关。在 PTSD 发展的患者中，61%接受了吗啡；在 PTSD 未发展的患者中，76%接受了吗啡（比值比，0.47；P<0.001）。在调整损伤严重程度、年龄、损伤机制、截肢状态和选定的与损伤相关的临床因素后，这种关联仍然显著。
我们的研究结果表明，在创伤护理中使用吗啡可能会降低严重损伤后随后发生 PTSD 的风险。
