《2018中国成人ICU镇痛和镇静治疗指南解读》.ppt

二、疼痛的评估治疗与监测 瑞芬太尼：正因为上述优势，近年来的研究发现瑞芬太尼能明显缩短机械通气时间及 ICU 住院时间［1-6］，瑞芬太尼在重症患者镇痛治疗中的应用逐渐增加。 通过整合关于瑞芬太尼与芬太尼、吗啡等其他阿片类镇痛药物在 ICU 患者镇痛中应用的比较，进行荟萃分析后发现瑞芬太尼能够缩短机械通气时间［MD=-0.42，95%CI：-0.71~ -0.13），P=0.004］，及减少 ICU 住院时间［MD=-0.82，95%CI：-1.48~-0.16）， P=0.01］。 1. Remifentanil-propofol analgo-sedation shortens duration of ventilation and length of ICU stay compared to a conventional regimen: A centre randomised, cross-over, open-label study in the Netherlands [J]. Intensive Care Med, 2009, 35(2): 291-298. 2. Impact of the use of propofol remifentanil goal-directed sedation adapted by nurses on the time to extubation in mechanically ventilated ICU patients: The experience of a French ICU [J]. Annales Fr Anesth, 2008, 27(6): 481. e481-481.e488. 3. Safety and ef?cacy of analgesia-based sedation with remifentanil versus standard hypnotic-based regimens in intensive care unit patients with brain injuries: a randomised, controlled trial [ISRCT [J]. Crit Care(London, England), 2004, 8(4): R268-280. 4. Remifentanil for analgesia and sedation in mechanically ventilated patients in intensive care unit [J]. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue, 2013, 25(3): 167-170. 5. Sedation in the intensive care unit with remifentanil/propofol versus midazolam/fentanyl: A randomised, open-label, pharmacoeconomic trial [J]. Crit Care, 2006, 10(3): R91. 6. A prospective, randomized, double-blind, multicenter study comparing remifentanil with fentanyl in mechanically ventilated patients [J]. Intensive Care Med, 2011, 37(3): 469-476. 二、疼痛的评估治疗与监测 舒芬太尼： 镇痛作用很强， 为芬太尼的 5~10 倍。国内的一项研究［1］ 表明舒芬太尼在 ICU 镇痛治疗中能减少镇静药物剂量。因其镇痛效果明确、起效快、蓄积小、对呼吸抑制作用小［2］，近年来在 ICU 重症患者中的应用也逐渐增多。 药物 安全范围 镇痛强度 起效时间 维持时间 分布容积（L/kg） 消除半衰期 瑞芬太尼 33000 100-200 30s 5-10min 0.2-0.4 9.1min 舒芬太尼 26716 1000 1-3min 30min 2.9 164min 芬太尼 277 100-200 1-2 30min 4.0 219min 吗啡 70-90 1 15-30min 240-300min 3.2 177min 布托啡诺 45 4-8 3-5min 3-5h 50 4-6h 常见药物药代动力学［3-8］ 1. 王书林 . 应用舒芬太尼联合丙泊酚为 ICU 机械通气患者进行镇痛镇静的效果观察 [J]. 当代医药论丛 , 2014, 13(12): 171-172.