重症患者的镇痛镇静治疗ppt参考课件.ppt

镇静镇痛 Canadian survey of the use of sedatives , analgesics , and neuromuscular blocking agent s in critically ill patients. Crit Care Med , 2006 Mehta S , Burry L , Fischer S , et A total of 273 of 448 eligible physicians (60%) responded. Daily interruption of continuous infusions of sedatives or analgesics is practiced by 40% of intensivists. A sedation scoring system is used by 49% of respondents. * The incidence of ICU uncomfortable events was as high as 96.9 % in the recruited 163 cases. 83 of 163 patients (50.9 %) experienced severe uncomfortable events (SUE) . Patients received MV longer than 48 hours showed a slight higher incidence of SUE, with no statistical significance , compared with those patients received MV less than 48 hours (59.7 % vs 44.8 %, P 0.05) . 61 patients received no sedatives nor analgesics showed significantly higher incidence of SUE compared with those patients received either sedatives or analgesics (73.8 % vs 37.3 %, P 0.01) . Systemic sedation based on analgesics could effectively protect patients from SUE (OR: 0.125 ; 95 %CI : 0.052 – 0.298 ; P 0101) , while no sedatives nor analgesics could do alone. A nationwide multi-center survey on the relationship between ICU uncomfortable experiences and sedation-analgesic strategy in mechanically ventilated patients. 2006 Ma Penglin , Li Qin , Liu Jingtao , et al * 镇痛镇静 镇痛镇静治疗是ICU的基本治疗 其狭义定义：特指应用药物手段以消除患者疼痛、减轻患者焦虑和躁动，催眠并诱导顺行性遗忘。 * 镇痛镇静 消除或减轻患者的疼痛及躯体不适感，减少不良刺激及交感神经系统的过度兴奋。 帮助和改善患者睡眠，诱导遗忘，减少或消除患者对其在ICU治疗期间病痛的记忆。 减轻或消除患者焦虑、躁动甚至谵妄，防止患者的无意识行为（挣扎…）干扰治疗，保护患者的生命安全。 降低患者的代谢速率，减少其氧耗氧需，使得机体组织氧耗的需求变化尽可能适应受到损害的氧输送状态，并减轻各器官的代谢负担。 镇痛镇静治疗的目的与意义 * 镇痛镇静治疗的指征 疼痛 焦虑 躁动 谵妄 睡眠障碍 * 镇痛被定义为减轻或消除疼痛和焦虑所引起的不良感受。 对于许多病人，疼痛可以被控制，但不能被完全解除。现有的疼痛治疗计划尚未取得广泛的成功 。 √ 医务人员反对足量使用镇痛药的偏见以及对药物 副作用或成瘾的担心都可能导致镇痛不足。 √病人对强镇痛药的恐惧以及对疼痛和镇痛药之间 关系的错误理解。 镇痛不足与过度的危害 关于镇痛： 所有危重病人有得到充分镇痛和自我疼痛管理的权利。