镇静镇痛的必要性ppt课件.ppt

客观评估指标 痛阈测定 生理生化指标 十 ICU镇痛的应用方法 University teaching Hospital Site selectio -ICU:Medical ICU Three-bed room -BRCU:Three-bed RCU room -SRCU:Single RCU room -PR:Private room on a genral medical floor Light monitoring Sound monitoring Patient Interrruptions -Vital sign,medication dosing,nursing care, respiratory care,diagnostic studies,medical exams,time with visitors Adverse Enviromental Condition in ICU Interruption level over 24h Average number of sound values80 dB for each 6h period Light levels (lux) and sound levels (dB) Averaged over 7d ICU患者需要镇静镇痛吗？ 应用镇痛镇静药的目的 内 容 提 要 Stress response Change endocrine function Hypermetabolism Sodium and water retention Increase lipolysis Sympathetic overactivity:HR RR Mvo2 Increase global and respiVo2 镇 静 不 足 Increase risk of DVT and PE Decrease in testinal motility Hypotension Reduce tissue oxygen extraction Prolong ICU stay Increase cost Excessive sedation Medical lCU 242 pats with MV Ramsay level-3 观察持续镇静对 MV时间的影响 持续镇静延长MV时间 Effect of spontaneous breathing on Ventilation-perfusion distribution in ARDS Keep patient comfortable But easily aroused 镇 静 目 标 对于需要快速苏醒的患者，丙泊酚为美国指南推荐的ICU镇静首选药物 美国《危重病成人患者持续使用镇静剂和止痛剂的临床实践指南》 需要快速苏醒时（例如，进行神经学评价或拔管），首选丙泊酚 镇静 咪唑安定仅建议短期使用，因为持续输入48-72小时以上时，它的苏醒时间和拔管时间无法预测. 中国指南推荐的ICU镇静药物 中国《ICU病人镇痛镇静治疗指南》 对急性躁动病人可以使用咪唑安定、安定或丙泊酚来获得快速的镇静 需要快速苏醒的镇静，可选择丙泊酚 短期的镇静可选用咪唑安定或丙泊酚 ICU病人镇痛镇静治疗指南（初稿）.中华医学会重症医学2006年全国学术研讨会, 5月11～15日,江苏南京. All excuses are too weak to release the burthen on our heart Care giver’s contribution Unexpected Extubation Am J Respir Crft Care Med 1994;157:1131 Previous Literatures Review(2001 ~ 2006) Percentage of patients with anxiety in their ICU stay 54 % ~ 73 % Conducted by Chinese Society of CCM Nationwide Survey (32 ICUs)Data collected from June 15-July 15, 234 ICU survivor were interviewed Current data in Chinese ICU Most of them felt discomfort 45% 10% 15% 30% Serious discomfort Comfort Amnesia Middle discomfort Slight discomfo