Department of Emergency Medicine, St. Anthony Hospital, Denver, Colorado, USA.
J Trauma Acute Care Surg. 2012 Mar;72(3):755-9. doi: 10.1097/TA.0b013e31823c4444.
Little is known about the safety of intravenous fentanyl for adult trauma patients in the prehospital setting. Our objective was to study the hemodynamic effect of prehospital intravenous fentanyl in initially normotensive adult trauma patients.
A quasi-experimental design was used to compare adult trauma patients who received intravenous fentanyl and those who did not receive fentanyl in a large regional prehospital system and its affiliated Level I trauma center. Emergent adult trauma patients were included with an initial prehospital Glasgow Coma Scale score of ≥13 and systolic blood pressure >90 mm Hg. Patients were stratified into two groups, those who received a single dose of intravenous fentanyl (100 μg) and those who did not. The outcome was initial emergency department (ED) shock index (heart rate divided by systolic blood pressure). Multivariable linear regression was used to estimate the effect of fentanyl on ED shock index while adjusting for prehospital shock index, age, gender, Trauma Injury Severity Score, and the propensity for receiving fentanyl.
Seven hundred sixty-three patients were included, of whom 217 (28%) received fentanyl. The groups had comparable demographics (age, gender, and race/ethnicity) but different clinical characteristics (ED vital signs, Injury Severity Score, mechanism, and ED disposition). The adjusted ED shock index of fentanyl patients improved (-0.03; 95% confidence interval: -0.05 to 0.00; p = 0.02) compared with no fentanyl.
Prehospital intravenous fentanyl did not adversely affect the initial ED shock index in adult trauma patients. Additional research should be performed to confirm and extend our findings.
III.
在院前环境中，对于成人创伤患者，静脉注射芬太尼的安全性知之甚少。我们的目的是研究院前静脉注射芬太尼对初始血压正常的成人创伤患者的血流动力学影响。
使用准实验设计，比较在一个大型区域性院前系统及其附属的一级创伤中心中接受和未接受静脉注射芬太尼的成人创伤患者。纳入初始院前格拉斯哥昏迷评分≥13 且收缩压>90mmHg 的紧急成年创伤患者。患者分为两组，一组接受单次静脉注射芬太尼（100μg），另一组不接受。主要结局为初始急诊室（ED）休克指数（心率除以收缩压）。多变量线性回归用于估计芬太尼对 ED 休克指数的影响，同时调整院前休克指数、年龄、性别、创伤严重度评分和接受芬太尼的倾向。
共纳入 763 例患者，其中 217 例（28%）接受了芬太尼。两组患者的人口统计学特征（年龄、性别和种族/民族）相似，但临床特征（ED 生命体征、损伤严重度评分、机制和 ED 处置）不同。芬太尼组的调整后 ED 休克指数改善（-0.03；95%置信区间：-0.05 至 0.00；p=0.02），与未使用芬太尼的组相比。
院前静脉注射芬太尼不会对成人创伤患者的初始 ED 休克指数产生不利影响。应进行更多研究以确认和扩展我们的发现。
III 级。
