Hofmann-Kiefer K, Praeger K, Fiedermutz M, Buchfelder A, Schwender D, Peter K
Institut für Anaesthesiologie, Klinikum Innenstadt, Ludwig-Maximilians-Universität München.
Anaesthesist. 1998 Feb;47(2):93-101. doi: 10.1007/s001010050533.
The aim of this study was to evaluate the quality of pain management in prehospital emergency care and to get more information about the administration of analgesics in prehospital patients.
Patients with painful diseases or injuries who had been brought to Munich hospital's were included in the study. Immediately after having reached the hospitals' emergency department, they were evaluated using a 101-point visual analogue scale for the severity of pain at four predefined periods. Information about the patient, the diagnosis, and the analgesic treatment used by the emergency teams were drawn from the patient's chart.
A total of 462 patients were included in the study. The mean pain score on arrival of the emergency team was 64 points; 36.5% of the patients were treated with analgesics. In 28.1% the emergency team tried to reduce pain through external measures (i.e., setting of fractures). In 35.3% there was no therapeutic intervention. In cases in which analgesic therapy was initiated, a definite reduction in pain was achieved during emergency care. Visual analogue scores decreased from 70 points at the beginning to 29 points at arrival to the hospital's emergency department. Analgesics were most frequently used for patients with cardiopulmonary diseases (47.2%), followed by patients with traumatic accidents (35.5%) and patients with acute abdominal pain (25.2%). Of the analgesics, opioids were given most frequently (87.0%). Nonopioid analgesic agents were used in 32.1%. The results of our investigation demonstrate that in many cases the administration of analgesics is not individualized to the patients needs.
During the prehospital period of emergency care many patients suffer from severe pain. The development of patient-oriented concepts concerning pain management could contribute to improvement of pain therapy in prehospital emergency medicine.
本研究的目的是评估院前急救中疼痛管理的质量，并获取更多关于院前患者镇痛药使用情况的信息。
纳入被送至慕尼黑医院的患有疼痛性疾病或损伤的患者。在到达医院急诊科后，立即在四个预先定义的时间段使用101点视觉模拟量表评估疼痛严重程度。关于患者、诊断以及急救团队使用的镇痛治疗的信息从患者病历中提取。
共有462例患者纳入本研究。急救团队到达时的平均疼痛评分为64分；36.5%的患者接受了镇痛药治疗。28.1%的患者中，急救团队试图通过外部措施（如骨折复位）减轻疼痛。35.3%的患者未进行治疗干预。在开始镇痛治疗的病例中，急救过程中疼痛明显减轻。视觉模拟评分从开始时的70分降至到达医院急诊科时的29分。镇痛药最常用于患有心肺疾病的患者（47.2%），其次是创伤事故患者（35.5%）和急性腹痛患者（25.2%）。在镇痛药中，阿片类药物使用最为频繁（87.0%）。非阿片类镇痛药的使用比例为32.1%。我们的调查结果表明，在许多情况下，镇痛药的使用并未根据患者需求个体化。
在院前急救期间，许多患者遭受严重疼痛。制定以患者为导向的疼痛管理理念有助于改善院前急救医学中的疼痛治疗。
