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美国卫生研究院文献>Pain Research Management
>Patient Controlled Analgesia for Adults with Sickle Cell Disease Awaiting Admission from the Emergency Department
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Patient Controlled Analgesia for Adults with Sickle Cell Disease Awaiting Admission from the Emergency Department
Background. A treatment algorithm for sickle cell disease (SCD) pain in adults presenting to a single emergency department (ED) was developed prioritizing initiation of patient controlled analgesia (PCA) for patients awaiting hospitalization. Objectives. Evaluate the proportion of ED visits in which PCA was started in the ED. Methods. A two-year retrospective chart review of consecutive SCD pain ED visits was undertaken. Data abstracted included PCA initiation, low versus high utilizer status, pain scores, bolus opioid number, treatment times, and length of hospitalization. Results. 258 visits resulted in hospitalization. PCA was initiated in 230 (89%) visits of which 157 (68%) were initiated in the ED. Time to PCA initiation was longer when PCA was begun after hospitalization versus in the ED (8.6 versus 4.5 hours, p < 0.001). ED PCA initiation was associated with fewer opioid boluses following decision to admit and less time without analgesic treatment (all p < 0.05). Mean pain intensity (MPI) reduction did not differ between groups. Among visits where PCA was begun in the ED, low utilizers demonstrated greater MPI reduction than high utilizers (2.8 versus 2.0, p = 0.04). Conclusions. ED PCA initiation for SCD-related pain is possible and associated with more timely analgesic delivery.
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机译:背景。已开发出了针对单一急诊科(ED)的成年人镰状细胞疾病(SCD)疼痛的治疗算法,优先考虑等待住院患者的患者开始自控镇痛(PCA)。目标。评估在ED中开始PCA的ED访问的比例。方法。进行了连续两年的SCD疼痛ED访视的两年回顾性图表审查。提取的数据包括PCA起始,使用率低与高,疼痛评分,阿片类药物推注次数,治疗时间和住院时间。结果。 258次就诊导致了住院。 PCA启动了230次(占89%),其中ED启动了157次(占68%)。住院后开始PCA的时间比ED中PCA启动的时间更长(8.6对4.5小时,p <0.001)。 ED PCA的启动与入院决定后的阿片类药物剂量减少和无镇痛药治疗的时间减少有关(所有p <0.05)。两组之间的平均疼痛强度(MPI)降低没有差异。在急诊中开始PCA的访问中,低使用率的人显示MPI的降低大于高使用率的人(2.8对2.0,p = 0.04)。结论。 ED PCA引发SCD相关性疼痛是可能的,并且可能与更及时的镇痛作用有关。
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