关于围术期疼痛管理探讨.ppt

 静脉注射羟考酮临床指南 （澳大利亚墨尔本Alfred医院） 羟考酮与其它药物间的相互作用 与其它中枢抑制药，如巴比妥类、苯二氮卓类、中枢性肌松药或吩噻嗪等合用可增强中枢抑制作用。 与纳洛酮或混合性激动拮抗剂合用会产生拮抗作用，从而削弱镇痛效果。 羟考酮的剂量转换 口服 : 静脉 = 1.5 : 1 静脉吗啡 : 静脉羟考酮 = 1 : 1 口服吗啡 : 口服羟考酮 = 2 : 1  静脉注射羟考酮临床指南 （澳大利亚墨尔本Alfred医院） 羟考酮静脉用药的常见副作用 便秘、恶心、尿储留和呕吐；头痛、头晕、嗜睡、失眠、欣快和瘙痒。 羟考酮静脉用药的严重副作用 呼吸抑制、过敏反应、低血压。 羟考酮静脉用药监护指标 镇痛效果 静息和活动时疼痛评分、活动功能评分（FAS） 中枢神经系统 镇静程度（LOS）≤1 呼吸频率 ≧8次/min 消化道症状 如，恶心、呕吐或便秘等。 血压 常用阿片类药物的等效关系 IV(mg) 作用时间（h） 哌替啶 100 4 羟考酮 10 4 吗啡 10 4-5 芬太尼 0.15-0.2 0.5-1 舒芬太尼 0.02 0.5-1 Pamela E. Macintyre, Stephan A. Schug. Acute Pain Management, A Practical Guide. 3rd Edition  小 结 羟考酮0.3mg/kg,用于麻醉诱导和维持，起效快，有效抑制气管插管时的过度心血管应激，有效止痛时间可持续4h； 对内脏痛优于吗啡 小剂量羟考酮，iv，q5min，在PACU可迅速有效缓解术后疼痛； 羟考酮PCIA可提供迅速、高效和安全的术后镇痛，部分指标优于舒芬太尼和吗啡。 --杭马 ---杭马 --杭马 感谢聆听！ 今时明月今时秋， 几度聚散几度欢， 犹思今朝阖府乐 ， 无复人间几月天。 * * Acute pain is perceived by the patient as stress. Consequently, in response to pain, a physiologic response with increased autonomic activity, such as hypertension, tachycardia, diaphoresis, and vasoconstriction, may result. However, the absence of tachycardia does not mean that the patient is not in pain.1 The sequelae of pain may trigger the following responses: Inflammatory Immunologic Metabolic Neurologic Endocrinologic Psychological The purposes of these physiologic responses are To prevent further tissue damage To maintain homeostasis To prevent death1 Clawson DR. Treatment of acute musculoskeletal pain. In: Loeser JD, Butler SH, Chapman CR, et al, eds. Bonica’s Management of Pain. 3rd ed. Philadelphia, PA: Lippincott Williams Wilkins; 2001:557-572. * The annual cost of pain is high. Medical expenses account for much of the cost, but lost income and reduced productivity also contribute to the overall economic burden. In 1987, low back pain alone was associated with $16 billion in annual costs in the USA, and chronic pain in general was associated with 4 billion lost workdays.1 In elderly patients, nonmalignant pain has been s