探讨对接受院前急救的多发性创伤患者进行早期镇痛治疗的效果。

将近期空军军医大学唐都医院急诊科收治的168例多发性创伤患者随机分为镇痛组和非镇痛组，2组均给予高级创伤生命支持治疗。此外，前者给予院前瑞芬太尼镇痛，后者给予同方式等剂量生理盐水。对比2组患者院前、院内首次生命体征、院内首次实验室检查指标以及临床资源消耗和院内死亡情况。

镇痛组患者入院首次的呼吸频率显著低于非镇痛组，动脉血二氧化碳分压值显著高于非镇痛组，红细胞分布宽度值显著低于非镇痛组（P＜0.01）。与非镇痛组相比，镇痛组患者ICU住院时长和住院总时长显著缩短，机械通气使用率显著减少（P＜0.01）。亚组分析中，在严重多发性创伤（ISS评分＞25）亚组中可观察到上述组间差异（P＜0.01），而在轻度（ISS≤16）和中度（16＜ISS≤5）多发性创伤亚组均未观察到上述差异。此外，严重多发性创伤亚组中，给予镇痛可使患者院内死亡率降低（P=0.03），但由于样本量少，仍需大样本研究进一步证实。

对接受院前急救的严重多发性创伤患者使用瑞芬太尼进行早期镇痛治疗的效果较好、安全性高，可显著缩短其在ICU住院的时间及住院总时间，并且有可能改善患者的院内生存情况，具有临床应用潜力。

To explore the effect of early analgesia on the prognosis of patients with multiple trauma receiving prehospital care.

A total of 168 patients with multiple trauma recently admitted to the department of emergency of our hospital were randomly divided into either an analgesia group or a non-analgesia group. Both groups were given Advanced Trauma Life Support. In addition, patients in the analgesic group were given analgesic therapy with remifentanil during the stage of prehospital emergency, and those in the non-analgesic group were given an equal volume of saline using the same method. Then, the first vital signs, the first laboratory examination indexes, the consumption of clinical resources, and hospital mortality were compared between the two groups.

Since hospital admission, the first result of respiratory rate was significantly lower and that of PCO₂ was significantly higher in the analgesia group than in the non-analgesia group. Red blood cell distribution width was significantly lower in the analgesia group than in the non-analgesia group (P＜0.01). Compared with the non-analgesic group, the ICU and hospital stay time were both significantly shortened and the rate of mechanical ventilation was significantly reduced in the analgesic group (P＜0.01). In subgroup analysis, all of the differences observed above existed in the subgroup of severe multiple trauma (ISS score＞25) (P＜0.01), but not in the subgroups characterized by mild (ISS≤16) and moderate (16＜ISS＜25) multiple trauma. Moreover, in the subgroup of severe multiple trauma, analgesic therapy can reduce the in-hospital mortality (P=0.03).

Remifentanil can be used for analgesic treatment of patients with severe multiple trauma during the stage of prehospital rescue with high safety. It can significantly shorten ICU and hospital stay time and may improve the hospital survival rate of patients. All of these benefits make prehospital analgesia be a potential clinical treatment under the background of emergency medicine.