摘要目的:探讨强化镇痛对急性创伤患者创伤后应激障碍（post-traumatic stress disorder，PTSD）发病的影响，为PTSD的防治拓展思路。方法:采用前瞻性观察性研究方法，以2018年1月至2019年11月就诊于徐州医科大学附属医院急救中心且符合纳入排除标准的创伤患者为研究对象。根据伤后30 d内平均疼痛评分的高低，分为强化镇痛组（<4分）和非强化镇痛组（≥4分）。收集入组患者的流行病学资料、创伤相关参数、VAS评分、PCL-5得分、HADS评分及PTSD发病情况；统计分析两组间各指标的差异。结果:共纳入84例符合条件的急性创伤患者，强化镇痛组39例、非强化镇痛组45例。两组患者基线资料比较，差异无统计学意义（均 P> 0.05）；强化镇痛组患者伤后1月时PTSD发生率、PCL-5总得分显著低于非强化镇痛组；HADS焦虑和抑郁评分也显著低于非强化镇痛组，差异有统计学意义（均 P< 0.05）。将镇痛药换算成地佐辛用量，强化镇痛组伤后30 d内镇痛药总用量显著高于非强化镇痛组，差异有统计学意义（ P< 0.05）。 结论:在急性创伤患者中，伤后强化镇痛可显著降低PTSD发生率，改善焦虑和抑郁症状。

abstractsObjective:To explore the influence of intensive analgesia on the incidence of post-traumatic stress disorder (PTSD) in acute trauma patients, and to develop new ideas for the prevention and treatment of PTSD.Methods:From January 2018 to November 2019, a prospective study was conducted on trauma patients who visited the Emergency Center of Affiliated Hospital of Xuzhou Medical University and met the enrollment criteria. The patients were divided into the intensive analgesia group (< 4) and non-intensive analgesia group (≥ 4) according to the mean pain score in 30 days. The epidemiological data, trauma-related parameters, analgesic schemes, VAS score, PCL-5 score, HADS score and incidence of PTSD of enrolled patients were collected. Appropriate statistical methods were used to analyze differences among the indicators between the two groups.Results:Eighty-four acute trauma cases were included in the study, 39 cases in the intensive analgesia group and 45 in the non-intensive analgesia group. There was no significant difference in baseline data between the two groups (all P>0.05). The incidence rate of PTSD and PCL-5 score of patients in the intensive analgesia group were all significantly lower than those in the non-intensive analgesia group in 1 month after the trauma (all P< 0.05). The HADS anxiety and depression scores of patients in the intensive analgesic group were significantly lower than those in the non-intensive analgesic group (all P< 0.05). All the analgesics were converted into the dosage of dezocine for comparison. The total dosage of analgesics (dezocine) used in patients of the intensive analgesia group was significantly higher than that in the non-intensive analgesia group within 30 days after injury ( P< 0.05). Conclusion:In the acute trauma patients, intensive analgesia after trauma can significantly reduce the incidence of PTSD as well as improve anxiety and depression symptoms.