休克病人的镇静镇痛治疗.ppt

休克患者的镇痛镇静;心源性休克的紧急处理 ;;Epidemiology of anxiety for MV patients;;休克时的交感风暴;紧张与恐惧发生在转运过程中;无机械通气病人更需要镇静; CPR时邻床清醒患者心律失常发生情况;Heart rate changes in near bed conscious patients during CPR ;SBP changes in near bed conscious patients during CPR ;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;有害的应激反应;降低患者的焦虑应激 改善组织灌注 ;;;;BACKGROUND:Anesthesia can become inadequate inadvertently or by misjudgment during surgery or emergence, and the surgical stress and pain stimulation will increase without adequate treatment. Overt stimulation may activate the sympathetic nervous system, increase the blood level of catecholamines, and lead to splanchnic arterial vasoconstriction.;; Using this rat model (surgical stress and pain stimulation on the intestinal microcirculation) , we found that dexmedetomidine can normalize global hemodynamics and prevent the alteration of intestinal microcirculation.;Sedation attenuated TNFα production ;Sedation improves early outcome in severely septic rats; 恰当的镇痛镇静可改善组织灌注. 有些我们看得见，有些看不见，但存在！;降低患者的焦虑应激 改善组织灌注 减少继发性损害;;镇静/镇痛控制应激与血管张力;病 例;血压 100/60 mm Hg、心率 145 次/分， 呼吸 38 次/分, 无哮鸣音，右下肺细湿啰音，左下肺呼吸音低， 血气分析：pH 7.48， PaCO2 31 mm Hg，PaO2 45 mm Hg（氧流量=4 L/min ）， 生化检查：Lac 4.1 mmol/L，余正常。;;;Rats were randomly received normal saline (1 mL/h), 1 mg/kg/hr or 10 mg/kg/hr propofol after haemorrhagic shock.;;10 mg/kg/hr ;;;;;Case reports began to appear in the pediatric literature linking unexplained deaths with the prolonged use of high-dose propofol infusions. This led to an early warning issued by the Danish Side Effect Committee in 1990. Notitis Fra Bivirkningsnaenet. Propofol (Diprivan) bivirkninger. Ugeskrr Laeger. 1990;152:1176. ;Parke TI, et al . Metabolic acidosis and fatal myocardial failure after propofol infusion in children: five case reports. . BMJ 1992; 305: 613–62;Propofol Infusion Syndrome ;诱发能量代谢障碍原因;临床预警特征;尿液颜色的显著变化;Guideline for sedation in patients with shock;Use