Augier R, Jenkins S, Bortolusso Ali S, Tennant I, Williams-Johnson J, Reid M
Department of Surgery, Radiology, Anaesthesia and Intensive Care, The University of the West Indies, Kingston 7, Jamaica; Sickle Cell Unit, Tropical Medicine Research Institute, The University of the West Indies, Kingston 7, Jamaica.
School of Medicine, Cardiff University, Cardiff, United Kingdom.
West Indian Med J. 2014 Jun;63(3):252-7. doi: 10.7727/wimj.2013.333. Epub 2014 Jun 12.
The aim of this survey was to establish the pain management approaches to acute painful crisis (APC) in sickle cell patients at two healthcare facilities and to compare with available guidelines.
A multi-centre observational survey of the management of APC in sickle cell patients was conducted. Data were collected at the Sickle Cell Unit (SCU), Tropical Medicine Research Institute (TMRI) and Accident and Emergency Department (A&E), University Hospital of the West Indies.
One hundred episodes of uncomplicated APC involving 81 patients managed at the SCU clinic and 64 episodes at the A&E in a total of 28 patients were included in the data set. Drugs used at the SCU included oral morphine, codeine and paracetamol and intramuscular diclofenac. At the A&E, parenteral morphine and pethidine were most commonly used. At the SCU, the mean time to initiation of analgesics was 38 minutes (IQR 25 to 50 minutes); at the A&E, this was 111 minutes (IQR 50 to 150 minutes). At the SCU, the mean duration of stay (DOS) was 2.9 hours (IQR 1.9 to 3.8 hours) with 94% of the patients being discharged home. At the A&E, the mean DOS was 13.0 hours (IQR 8.3 to 16.9 hours) with 93% of the patients being discharged home. The A&E patient group contained multiple high frequency presenters. Documentation of pain severity scores was inconsistent.
The findings of the survey indicate that the management of APC at the two centres is substantially different. Further study is required to investigate patient satisfaction, centre preference and analgesic therapy efficacy.
本调查旨在确定两家医疗机构对镰状细胞病患者急性疼痛危象（APC）的疼痛管理方法，并与现有指南进行比较。
对镰状细胞病患者的APC管理进行了多中心观察性调查。数据收集于西印度群岛大学医院的镰状细胞病科（SCU）、热带医学研究所（TMRI）以及急诊科（A&E）。
数据集中包括在SCU诊所管理的81例患者的100次无并发症APC发作，以及在A&E的28例患者中的64次发作。SCU使用的药物包括口服吗啡、可待因和对乙酰氨基酚以及肌肉注射双氯芬酸。在A&E，最常用的是胃肠外吗啡和哌替啶。在SCU，开始使用镇痛药的平均时间为38分钟（四分位间距25至50分钟）；在A&E，这一平均时间为111分钟（四分位间距50至150分钟）。在SCU，平均住院时间（DOS）为2.9小时（四分位间距1.9至3.8小时），94%的患者出院回家。在A&E，平均住院时间为13.0小时（四分位间距8.3至16.9小时），93%的患者出院回家。A&E患者组中有多个高频就诊者。疼痛严重程度评分的记录不一致。
调查结果表明，两个中心对APC的管理存在很大差异。需要进一步研究以调查患者满意度、中心偏好和镇痛治疗效果。
