Jones J S, Johnson K, McNinch M
Department of Emergency Medicine, Michigan State University College of Human Medicine, Grand Rapids 49503, USA.
Am J Emerg Med. 1996 Mar;14(2):157-60. doi: 10.1016/S0735-6757(96)90123-0.
Inadequate treatment of pain, which has been termed as "oligoanalgesia", appears to be common in a number of practice settings, including the emergency department (ED). The purpose of this study was to determine whether elderly patients with isolated long-bone fractures are less likely to receive analgesics in the ED than a similar cohort of younger patients. Consecutive adult patients (aged 20 to 50 years or older than 70 years) presenting to the ED with isolated long-bone fractures were evaluated using a retrospective cohort study design. Patient demographics, ED treatment, and disposition were analyzed (t tests, chi2) to identify significant differences between the two age groups. Analgesic use was recorded as oral or parenteral, nonnarcotic or narcotic, and low or high dose (less than or at least the equivalent of 10 mg parenteral morphine sulfate, respectively). A total of 231 patients met the inclusion criteria, of whom 109 were elderly (mean age, 80.6 +/- 7.4 years) and 122 nonelderly (mean age 33.9 +/- 8.0 years). Nonelderly patients were more likely than the elderly to receive ED pain medication (80% vs 66%, P =.02) within a shorter period of time (mean 52 min vs 74 min, P = .02), and at a higher equivalent dose (44% vs 19%, P = .002). Younger patients also tended to receive more narcotic medications (98% vs 89%, P = .03). Inadequate use of analgesics in adult ED patients with acute fractures appears to be common. A chronologic basis for variability in analgesic practice needs to be further characterized.
疼痛治疗不足，即所谓的“镇痛不足”，在包括急诊科（ED）在内的许多医疗环境中似乎很常见。本研究的目的是确定孤立性长骨骨折的老年患者在急诊科接受镇痛药治疗的可能性是否低于类似的年轻患者队列。采用回顾性队列研究设计，对连续就诊于急诊科的孤立性长骨骨折成年患者（年龄在20至50岁或70岁以上）进行评估。分析患者人口统计学、急诊科治疗和处置情况（t检验、卡方检验），以确定两个年龄组之间的显著差异。镇痛药的使用记录为口服或胃肠外给药、非麻醉性或麻醉性、低剂量或高剂量（分别低于或至少相当于10mg胃肠外硫酸吗啡）。共有231例患者符合纳入标准，其中109例为老年人（平均年龄80.6±7.4岁），122例为非老年人（平均年龄33.9±8.0岁）。非老年患者比老年患者更有可能在更短的时间内（平均52分钟对74分钟，P = 0.02）接受急诊科疼痛药物治疗（80%对66%，P = 0.02），且等效剂量更高（44%对19%，P = 0.002）。年轻患者也倾向于接受更多的麻醉性药物（98%对89%，P = 0.03）。成年急诊科急性骨折患者镇痛药使用不足似乎很常见。镇痛实践中变异性的时间顺序基础需要进一步明确。
