肋骨骨折的急性疼痛管理:一个叙事审查
Thomas Ulrich Bresgen1, Francesco Salinaro2, Bruno Barcella2
1Emergency Unit, Ospedale Maggiore Di Lodi, Italy; Emergency Medicine Unit and Emergency Medicine Postgraduate Training Program, IRCCS Fondazione Policlinico San Matteo, Department of Internal Medicine, University of Pavia, Italy.
Injury
|November 12, 2025
概括
肋骨骨折的有效疼痛管理涉及多模式止痛,结合各种策略. 虽然阿片类药物很常见,但非阿片类药物和区域麻醉技术为更好的患者结果提供了更安全,更有效的替代方案.
科学领域:
- 疼痛管理 疼痛管理
- 创伤护理 创伤护理
- 麻醉学 麻醉学
背景情况:
- 肋骨骨折很常见,并与呼吸衰竭和慢性疼痛等严重并发症有关.
- 优化疼痛管理对于改善结局和减少肋骨骨折患者的发病率至关重要.
- 目前用于肋骨骨折的多模式止痛策略缺乏标准化.
研究的目的:
- 审查和综合当前关于肋骨骨折患者急性疼痛管理的止痛策略的证据.
主要方法:
- 进行了随机对照试验 (RCT) 的叙述性综述,这些试验涉及伤肋骨骨折的止痛疗法.
- 搜索了PubMed和Scopus的相关RCT,包括药理学,非药理学和区域麻醉干预.
- 排除了关于手术治疗,非创伤性骨折或非RCT设计的研究;47个RCT符合纳入标准.
主要成果:
- 阿片类药物受到广泛研究,但具有风险,特别是在老年人中.
- 非阿片类药物 (NSAID,) 是有效的阿片类药物节约策略.
- 区域麻醉 (表皮,副脊椎,ESP,SAP阻塞) 提供更好的疼痛和呼吸系统益处,但具有学习曲线和风险.
- 非药理学方法 (冷疗法,TENS,动力测试) 显示出潜力,但证据有限.
结论:
- 多模式止痛,结合药物,非药物和区域麻醉,是多重肋骨骨折的最有效策略.
- 在当前的多式模式止痛疗法中存在显著的异质性.
- 需要进一步的研究来规范方案,并评估长期的,以患者为中心的结果.
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