浅镇静,要多浅？.pptx

浅镇静，要多浅？;“….But what I see these days are paralyzed, sedated patients, Lying without motion, appearing to be dead, except for the Monitors that tell me otherwise.” Thomas L. Petty;当今镇静所关注的问题;;Rationales for light Sedation ;Benefit from light sedation;;;Light versus deep sedation on mental health after critical illness; 区别什么是浅镇静和深镇静. 解释浅镇静的临床预后. 临床试验研究. ;Proportion of time spent on target Ramsay sedation goal;;死亡率, 住院时间, 器官衰竭,机械通气时间 ;Lancet 2010; 375: 475–80;轻度镇静还是不镇静?;Sedatives and morphine usage;镇静组Propofol 实际给与量： 54.11mg/hr (中位数) =1% propofol 5-6ml/hr 还有咪唑安定+吗啡 =至少有50%患者是过度镇静;避免过度镇静造成的不良影响;The incidence of sub-optimal sedation in the ICU: a systematic review;Critical Care 2009, 13:R204;过度镇静的发生率;深镇静与MV病人预后;镇静负作用 ICU获得性感染发生率;FOR SEVERE AGITATION, Lorazepam 1-2 mg IM/IV !;Daily interruption of sedatives infusion in critically ill patients with MV;缩短机械通气天数;Treatment protocols;Outcomes; Survival at 1 year;Outcomes;浅镇静不能过浅;2013年PAD临床指南;;镇静/镇痛药物与休克组织损伤 Rats were randomly received normal saline (1 mL/h), 1 mg/kg/hr or 10 mg/kg/hr propofol after haemorrhagic shock. ;Light sedation protect organs from inflammatory injury;Plasma epinephrine alterations in near bed conscious patients during CPR ; CPR时邻床清醒患者心律失常发生情况;Sequential Use of Mid and Prop for Long-Term Sedation in Postoperative MV Pts;The incidence of agitation during Wake-up;Cases (%)of BP and HR variation;Memory,anxiety,depression and PTSD in MV patients 5 days and 2 months post-ICU ;Kaplan-Meier Curves for Time to Successful Extubation;Problems in “No sedation”;Delirium duration and mortality in lightly sedated, mechanically ventilated intensive care patients;发生谵妄天数;A randomized trial of intermittent lorazepam vs propofol with daily interruption in MV patients183;Benefit from light sedation;Favorable population;浅镇静方案：序贯镇静（STDS）和目标制定性镇静方案（EGDS）;;总结：浅镇静，要多浅？;Thank you for your attention;;;Theoretic intracranial compliance curves. (From