Abstract：
The acute pain crisis (APC) is the commonest complication of sickle cell disease (SCD). Severe episodes may require treatment in hospital with strong opioid analgesic drugs, combined with additional supportive care measures. Guidelines for APC management have been produced over the past two decades gathering evidence from published studies, expert opinion, and patient perspective. Unfortunately, reports from multiple sources indicate that guidelines are often not followed, and that acute care in emergency departments and on acute medical wards is suboptimal. It is important to understand what leads to this breakdown in health care, and to identify evidence-based interventions which could be implemented to improve care. This review focuses on recently published articles as well as information about on-going clinical trials. Aspects of care which could potentially make a difference to patient experience include availability and accessibility of individual care plans agreed between patient and treating specialist, innovative means of delivering initial opioids to reduce time to first analgesia, and availability of a specialist unit away from the ED, where expert care can be delivered in a more compassionate environment. The current evidence of improved outcomes and health economic advantage with these interventions is inadequate, and this is hampering their implementation into health care systems.
摘要：
急性疼痛危象(APC)是镰状细胞病(SCD)最常见的并发症。严重发作可能需要在医院使用强阿片类镇痛药治疗，结合额外的支持性护理措施。在过去的二十年中，从已发表的研究中收集证据，制定了APC管理指南。专家意见,和病人的观点。不幸的是,来自多个来源的报告表明，准则往往没有得到遵守，急诊科和急性内科病房的急性护理并不理想。重要的是要了解导致医疗保健崩溃的原因，并确定可以实施的循证干预措施，以改善护理。这篇综述的重点是最近发表的文章以及有关正在进行的临床试验的信息。可能对患者体验产生影响的护理方面包括患者和治疗专家之间商定的个人护理计划的可用性和可及性，提供初始阿片类药物以减少首次镇痛时间的创新方法，以及远离ED的专家单位的可用性，可以在更富有同情心的环境中提供专家护理。这些干预措施改善结果和健康经济优势的当前证据不足，这阻碍了他们在医疗保健系统中的实施。
