创伤院前镇痛：当前证据的系统综述。
完整摘要 · 中文译文
目的：疼痛管理是院前创伤护理中不可或缺的一部分。然而，由于多重挑战，尽管疼痛具有重要的生理和心理影响，其治疗仍经常不足。这些挑战中包括对途中给药药物的安全性和有效性的不确定性。我们旨在评估院前药物镇痛对急性受伤成人创伤患者的安全性和有效性的证据水平。 方法：对PUBMED、Google Scholar、Cochrane Library、Embase和Scopus进行电子数据库检索，查找从2014年1月1日至2026年1月1日期间报告院前药物镇痛对急性受伤成人（年龄>15岁）安全性和/或有效性的研究。排除非原始研究、儿科研究、非药物制剂或非全身给药（如局部给药）的研究。 结果：共有17项研究符合纳入标准，涉及17，115名患者。这些研究包括6项随机对照试验、5项回顾性队列研究、1项回顾性比较研究、1项回顾性观察性研究、2项前瞻性观察性研究、1项前瞻性队列研究和1项非随机临床试验。所用药物包括阿片类药物、氯胺酮、甲氧氟烷和对乙酰氨基酚。除一项阿片类药物治疗研究外，未报告任何由药物导致的严重不良事件。恶心、头晕、烦躁、激动和嗜睡等轻微不良反应较为常见。所有药物均显示出不同程度的效果。 结论：当前 现有证据表明，院前镇痛用于成人创伤患者总体上具有良好的安全性和有效性。然而，考虑到损伤相关疼痛在院前环境中普遍存在，现有证据在范围、方法学及治疗方案差异方面仍存在局限性。
完整摘要 · 英文原文
OBJECTIVES: Pain management is integral to prehospital trauma care. However, due to multiple challenges, pain is frequently undertreated despite important physiologic and psychologic implications. Among these challenges is uncertainty regarding the safety and effectiveness of pharmacologic agents administered enroute. We aimed to evaluate the level of evidence for the safety and effectiveness of prehospital pharmacologic analgesia for acutely injured adult trauma patients. METHODS: An electronic database search of PUBMED, Google Scholar, Cochrane Library, Embase and Scopus for studies that reported on safety and/or effectiveness of prehospital pharmacologic analgesia for acutely injured adults (aged > 15 years) from January 1st, 2014, to January 1st, 2026. Non-original studies, paediatric studies, studies of non-pharmacologic agents or non-systemic administration (e.g., topical) were excluded. RESULTS: Seventeen studies, involving 17,115 patients, met the inclusion criteria. The studies consisted of 6 randomized controlled trials, 5 retrospective cohort studies, one retrospective comparative study, one retrospective observational study, two prospective observational studies, one prospective cohort study and one non-randomized clinical trial. Agents included opioids, ketamine, methoxyflurane and paracetamol. Apart from one study of opioid therapy, no drug-attributed serious adverse events were reported. Minor adverse effects such as nausea, dizziness, dysphoria, agitation and drowsiness were common. All agents demonstrated effectiveness to varying levels. CONCLUSIONS: Current evidence demonstrates an overall favourable safety and effectiveness profile of prehospital analgesia for adult trauma patients. However, considering the wide prehospital prevalence of injury-related pain, evidence is limited by scope, methodology and variations of treatment protocols.