急诊分层多模式疼痛护理对创伤性骨折患者康复疗效的循证分析

An Evidence-Based Analysis of Emergency Stratified Multimodal Pain Management on the Recovery of Patients with Traumatic Fractures

摘要: 目的：系统整合近5年急诊创伤领域随机对照试验、网状Meta分析、急诊创伤疼痛管理指南、多中心队列研究，明确急诊创伤性骨折患者急性期疼痛独立危险因素与疼痛介导的康复阻滞机制，构建急诊即刻评估分层、药物–物理–中医–心理一体化多模式疼痛护理路径，量化分析标准化疼痛护理对急诊创伤骨折患者疼痛强度、应激炎症水平、并发症、功能康复、住院周期、远期慢性创伤痛及就医满意度的改善效果，为急诊专科规范化疼痛护理提供高级别循证依据。方法：检索PubMed、Cochrane Library、Web of Science、CNKI、万方、维普数据库，检索时限2021年1月~2026年5月；纳入急诊创伤骨折急性疼痛护理相关系统评价、样本量 ≥ 100例RCT、前瞻性多中心队列、国内外急诊创伤诊疗指南；采用CochraneRoB2、JBI、AGREE II、AMSTAR2完成文献质量评价，GRADE分级证据强度，采用描述性整合对比常规急诊护理与分层多模式疼痛护理的康复结局差异。结果：传统急诊同质化护理模式下，创伤骨折患者入院即刻NRS疼痛评分均值7.4~8.9分，伤后24 h血清IL-6、TNF-α炎症因子显著升高，72 h内躁动、失眠、焦虑发生率76.2%，功能锻炼依从性不足40%，平均住院7.2~9.1 d，伤后6个月慢性持续性疼痛发生率27.3%；高龄、多发骨折、开放性骨折、合并颅脑/胸腹腔损伤、创伤前焦虑、骨折部位靠近神经干为高危疼痛人群。急诊分层多模式疼痛护理干预可使入院1 h NRS降至3.1~4.0分，24 h炎症因子水平下降49.6%，躁动、焦虑发生率降低68.5%，功能锻炼依从性提升57.3%，平均住院缩短1.6~2.3 d，伤后半年慢性创伤痛发生率降至8.1%~12.5%，镇痛药物总消耗量下降53.7%，无呼吸抑制、严重胃肠道损伤等不良反应增多。结论：急诊即时启动的分层多模式疼痛护理可快速阻断创伤急性疼痛传导、抑制全身炎症应激、消除心理疼痛放大效应，从急性期改善远期肢体功能恢复，降低慢性创伤痛发生风险，契合急诊创伤快速救治与全程康复一体化理念，适合各级医院急诊创伤单元标准化落地实施。

Abstract: Objective: To systematically integrate randomized controlled trials, network meta-analyses, emergency trauma pain management guidelines, and multicenter cohort studies from the past five years in the field of emergency trauma. The goal is to identify independent risk factors for acute pain in emergency trauma fracture patients and explore the pain-mediated mechanisms that hinder rehabilitation, as well as to build a comprehensive, multi-modal pain care pathway—covering immediate emergency assessment, drugs, physical therapy, traditional Chinese medicine, and psychological support. The study also aims to quantify how standardized pain care impacts pain intensity, stress and inflammatory levels, complications, functional recovery, hospital stay, long-term chronic post-traumatic pain, and patient satisfaction, providing high-level evidence for specialized emergency pain care. Methods: Databases searched included PubMed, Cochrane Library, Web of Science, CNKI, Wanfang, and VIP, covering the period from January 2021 to May 2026. Studies included were systematic reviews on acute pain care in emergency trauma fractures, RCTs with sample sizes ≥100, prospective multicenter cohorts, and domestic and international emergency trauma treatment guidelines. Literature quality was evaluated using Cochrane RoB2, JBI, AGREE II, and AMSTAR2, while evidence strength was graded with GRADE. Descriptive comparisons were made between conventional emergency care and stratified multi-modal pain care in terms of rehabilitation outcomes. Results: Under conventional uniform emergency care, trauma fracture patients had an initial NRS pain score of 7.4~8.9 at admission, with significantly elevated serum IL-6 and TNF-α 24 hours post-injury. Within 72 hours, agitation, insomnia, and anxiety occurred in 76.2% of patients, functional exercise compliance was below 40%, average hospital stay was 7.2~9.1 days, and the incidence of chronic persistent pain at 6 months post-injury was 27.3%. High-risk pain populations included elderly patients, those with multiple fractures, open fractures, combined head or thoracoabdominal trauma, pre-injury anxiety, or fractures near major nerve trunks. Emergency stratified multi-modal pain care intervention reduced 1-hour admission NRS scores to 3.1~4.0, lowered inflammatory markers at 24 hours by 49.6%, reduced agitation and anxiety rates by 68.5%, improved functional exercise compliance to 57.3%, shortened hospital stays by 1.6~2.3 days, and decreased the incidence of chronic traumatic pain at six months to 8.1%~12.5%. Total analgesic consumption dropped by 53.7%, with no increase in adverse effects such as respiratory depression or severe gastrointestinal injury. Conclusions: Implementing stratified multi-modal pain care immediately in the emergency setting can quickly block acute pain signals, suppress systemic inflammatory stress, and mitigate psychological amplification of pain. This approach not only enhances long-term limb function recovery but also reduces the risk of chronic traumatic pain, aligning with the concept of rapid emergency rescue and integrated full-course rehabilitation. It is suitable for standardized implementation in emergency trauma units across various hospital levels.