Gabram S G, Schwartz R J, Jacobs L M, Lawrence D, Murphy M A, Morrow J S, Hopkins J S, Knauft R F
Department of Emergency Medicine/Trauma, Hartford Hospital, Connecticut 06115, USA.
World J Surg. 1995 May-Jun;19(3):388-93. doi: 10.1007/BF00299166.
Optimal pain management is essential in blunt trauma patients sustaining significant chest trauma. The purpose of this randomized prospective trial was to measure the difference in pulmonary function in nonintubated patients with unilateral multiple rib fractures receiving two modalities of pain relief: systemic narcotic medications alone or local anesthetics given by intrapleural catheter (IPCs). Forty-two patients were randomized to receive systemic narcotic medications or IPCs for pain control. The patients with IPCs statistically had more compromised pulmonary function as measured by forced vital capacity (FVC) on admission; however, they tended toward a greater objective improvement of FVC on discharge. When analyzing a cohort of severely impaired patients (initial FVC < 20%), half of the systemic medication patients compared to only 10% of the IPC group failed and required another mode of therapy. Catheter complications were minor and did not contribute to overall morbidity. The IPC patients had fewer failures than the systemic medication patients.
对于遭受严重胸部创伤的钝性创伤患者，优化疼痛管理至关重要。这项随机前瞻性试验的目的是测量接受两种疼痛缓解方式的非插管单侧多根肋骨骨折患者的肺功能差异：单独使用全身麻醉药物或通过胸膜内导管（IPC）给予局部麻醉剂。42名患者被随机分配接受全身麻醉药物或IPC进行疼痛控制。通过入院时的用力肺活量（FVC）测量，接受IPC的患者在统计学上肺功能受损更严重；然而，他们在出院时FVC的客观改善趋势更大。在分析一组严重受损患者（初始FVC<20%）时，全身用药患者中有一半治疗失败，需要另一种治疗方式，而IPC组只有10%。导管并发症轻微，对总体发病率没有影响。IPC患者的治疗失败率低于全身用药患者。
