Anantha Ram V, Stewart Tanya Charyk, Rajagopalan Aarthi, Walsh Jillian, Merritt Neil H
Department of Surgery, Western University, London, Ontario, Canada.
Trauma Program, Children's Hospital, London Health Sciences Centre, London, Ontario, Canada.
Injury. 2014 May;45(5):845-9. doi: 10.1016/j.injury.2013.10.048. Epub 2013 Nov 12.
The objective of this study was to evaluate the use of analgesia in the resuscitative phase of severely injured children and adolescents.
A retrospective cohort of paediatric (age<18 years), severely injured (ISS≥12) patients were identified from the London Health Sciences Centre's Trauma Registry from 2007 to 2010. Variables were compared between Analgesia and Non-analgesia groups with Pearson Chi-square and Mann-Whitney U tests. Resuscitative analgesia use was assessed through multivariable logistic regression controlling for age, gender, mechanism, arrival and Trauma Team Activation (TTA).
Analgesia was used in 32% of cases. Univariate analysis did not reveal any differences in gender, age, injury type, injury profile and arrival patterns. Significant differences were found with analgesia used more frequently in patients injured in a motor vehicle collision (58% vs. 42%, p=0.026) and having parents in the resuscitation room (17% vs. 6%, p=0.01). Analgesia patients were more injured (median ISS 22 vs. 17, p=0.027) and had 2.25 times more TTA (39% vs. 17%). Logistic regression revealed patients arriving directly to a trauma centre had a higher incidence of receiving analgesia (OR 2.01, 95% CI: 1.03-3.93), as did TTA (OR 2.18, 95% CI: 1.01-4.73) and having parents in resuscitation room (3.56, 95% CI: 1.23-10.33). Narcotics were most commonly used (85%), followed by benzodiazepines (16%), with 66% given during the primary survey.
Use of analgesia is important in the acute management of paediatric trauma. Direct presentation to a level I trauma centre, TTA and the presence of parents lead to higher appropriate use of analgesia in paediatric trauma resuscitation.
本研究的目的是评估在严重受伤的儿童和青少年复苏阶段使用镇痛措施的情况。
从伦敦健康科学中心2007年至2010年的创伤登记中确定一组儿科（年龄<18岁）、严重受伤（损伤严重度评分[ISS]≥12）患者的回顾性队列。使用Pearson卡方检验和Mann-Whitney U检验对镇痛组和非镇痛组之间的变量进行比较。通过多变量逻辑回归评估复苏期镇痛的使用情况，该回归对年龄、性别、受伤机制、到达情况和创伤团队启动（TTA）进行了控制。
32%的病例使用了镇痛措施。单因素分析未发现性别、年龄、损伤类型、损伤情况和到达方式存在差异。发现机动车碰撞受伤患者（58%对42%，p = 0.026）以及复苏室中有父母陪伴的患者（17%对6%，p = 0.01）更频繁地使用镇痛措施。使用镇痛措施的患者受伤更严重（ISS中位数22对17，p = 0.027），TTA次数多2.25倍（39%对17%）。逻辑回归显示，直接到达创伤中心的患者接受镇痛的发生率更高（比值比[OR]2.01，95%置信区间[CI]：1.03 - 3.93），TTA患者也是如此（OR 2.18，95% CI：1.01 - 4.73），以及复苏室中有父母陪伴的患者（3.56，95% CI：1.23 - 10.33）。最常用的是麻醉药品（85%），其次是苯二氮䓬类药物（16%），66%在初次检查期间给予。
在儿科创伤的急性处理中使用镇痛措施很重要。直接就诊于一级创伤中心、TTA以及有父母在场会使儿科创伤复苏中镇痛措施的合理使用增加。
