切换至 "中华医学电子期刊资源库"

第五届中国出版政府奖音像电子网络出版物奖提名奖

中国科技核心期刊

中国科学引文数据库(CSCD)来源期刊

中华重症医学电子杂志 ›› 2017, Vol. 03 ›› Issue (04) : 258 -261. doi: 10.3877/cma.j.issn.2096-1537.2017.04.005

所属专题: 镇痛镇静 重症医学 文献

专题笔谈

镇痛镇静评估方法的局限与进步
李晖1, 黄青青1,()   
  1. 1. 650101 昆明医科大学第二附属医院重症医学科
  • 收稿日期:2017-05-15 出版日期:2017-11-28
  • 通信作者: 黄青青

The limitations and progress of analgesia and sedation assessments

Hui Li1, Qingqing Huang1,()   

  1. 1. Department of Critical Care Medicine, the Second Affiliated Hospital of Kunming Medical University, Kunming 650101, China
  • Received:2017-05-15 Published:2017-11-28
  • Corresponding author: Qingqing Huang
  • About author:
    Corresponding author: Huang Qingqing, Email:
引用本文:

李晖, 黄青青. 镇痛镇静评估方法的局限与进步[J]. 中华重症医学电子杂志, 2017, 03(04): 258-261.

Hui Li, Qingqing Huang. The limitations and progress of analgesia and sedation assessments[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2017, 03(04): 258-261.

由于自身疾病的特点以及多种不利因素的影响,ICU患者通常处于各种强烈的应激状态之中,为了有效地控制这些不良的应激反应,应用镇痛、镇静方法已成为治疗常规。然而研究证实,镇静过度或者镇静不足都会带来诸多不良的结果,如机械通气时间延长、呼吸机相关性肺炎(VAP)的发生风险增高以及谵妄发生率、ICU病死率增加等。因此,如何有效地管理好ICU患者的镇痛镇静,除镇痛镇静策略上的改进外,对镇痛镇静深度做到实时、准确的评估尤为重要。本文将对目前临床上常用的镇痛镇静评估方法各自的特点及优缺点做简要阐述。

ICU patients are in a various of intense stress state due to their diseases and other factors. Analgesic and sedative treatments are routine used to control these adverse stress responses effectively. However, studies have shown that both over and lack of sedation can lead to many adverse outcomes, such as prolonged mechanical ventilation, ventilator-associated pneumonia (VAP), and increased delirium and mortality. Therefore, in addition to improved analgesic and sedative strategies, real-time and accurate assessment is important for analgesic and sedative management in ICU patients. Here, we review the characteristics of each analgesic and sedative assessments that widely used in clinic.

1
Jackson DL, Proudfoot CW, Cann KF, et al. The incidence of sub-optimal sedation in the ICU: a systematic review [J]. Crit Care, 2009, 13(6):R204.
2
Chanques G, Sebbane M, Barbotte E, et al. A prospective study of pain at rest: incidence and characteristics of an unrecognized symptom in surgical and trauma versus medical intensive care unit patients [J]. Anesthesiology, 2007, 107(5):858-860.
3
Payen JF, Chanques G, Mantz J, et al. Current practices in sedation and analgesia for mechanically ventilated critically ill patients:a prospective multicenter patient-based study [J]. Anesthesiology,2007, 106(4):687-695.
4
Rotondi AJ, Chelluri L, Sirio C, et al. Patients′ recollections of stressful experiences while receiving prolonged mechanical ventilation in an intensive care unit [J]. Crit Care Med, 2002, 30(4):746-752.
5
Gélinas C. Management of pain in cardiac surgery ICU patients: have we improved over time [J]. Intensive Crit Care Nurs, 2007, 23(5):298-303.
6
Schelling G, Richter M, Roozendaal B, et al. Exposure to high stress in the intensive care unit may have negative effects on health-related quality-of-life outcomes after cardiac surgery [J]. Crit Care Med, 2003, 31(7):1971-1980.
7
Chanques G, Viel E, Constantin JM, et al. The measurement of pain in intensive care unit: comparison of 5 self-report intensity scales [J]. Pain, 2010, 151(3):711-721.
8
Pudas-Tähkä SM, Axelin A, Aantaa R, et al. Pain assessment tools for unconscious or sedated intensive care patients: a systematic review [J]. J Adv Nurs, 2009, 65(5):946-956.
9
Barr J, Fraser GL, Puntillo K, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit [J]. Crit Care Med, 2013,41(1):263-306.
10
Gélinas C. Pain assessment in the critically ill adult: Recent evidence and new trends [J]. Intensive Crit Care Nurs, 2016, 34:1-11.
11
Cade CH. Clinical tools for the assessment of pain in sedated critically ill adults [J]. Nurs Crit Care, 2008, 13(6):288-297.
12
Wibbenmeyer L, Sevier A, Liao J, et al. Evaluation of the usefulness of two established pain assessment tools in a burn population [J]. J Burn Care Res, 2011, 32(1):52-60.
13
Ramsay MA, Savege TM, Simpson BR, et al. Controlled sedation with alphaxalone-alphadolone [J]. Br Med J, 1974, 2(5920):656-659.
14
Sessler CN, Gosnell MS, Grap MJ, et al. The Richmond Agitation-Sedation Scale:Validity and reliability in adult intensive care unit patients [J]. Am J Respir Crit Care Med, 2002, 166(10):1338-1344.
15
Riker RR, Picard JT, Fraser GL. Prospective evaluation of the Sedation-Agitation Scale for adult critically ill patients [J]. Crit Care Med, 1999, 27(7):1325-1329.
16
Shannon K, Bucknall T. Pain assessment in critical care:what have we learnt from research [J]. Intensive Crit Care Nurs, 2003, 19(3):154-162.
17
Stein EJ, Glick DB. Advances in awareness monitoring technologies [J]. Curr Opin Anaesthesiol, 2016, 29(6):711-716.
18
吴新民,于布为,叶铁虎, 等. 术中知晓预防和脑功能监测快捷指南 [J]. 中国继续医学教育, 2011, 3(10):139-140.
19
李晖,黄青青,苏美仙, 等. 脑电双频谱指数监测重症监护室机械通气患者镇静水平的准确性 [J]. 中华麻醉学杂志, 2009, 29(5):443-445.
20
Bagchi D, Mandal MC, Das S, et al. Bispectral index score and observer′s assessment of awareness/sedation score may manifest divergence during onset of sedation: Study with midazolam and propofol [J]. Indian J Anaesth, 2013, 57(4):351-357.
21
Sessler CN, Grap MJ, Ramsay MA. Evaluating and monitoring analgesia and sedation in the intensive care unit [J]. Crit Care, 2008, 12(Suppl 3):S2.
22
LeBlanc JM, Dasta JF, Kane-Gill SL. Role of the bispectral index in sedation monitoring in the ICU [J]. Ann Pharmacother, 2006, 40(3):490-500.
23
Pilge S, Kreuzer M, Karatchiviev V, et al. Differences between state entropy and bispectral index during analysis of identical electroencephalogram signals:a comparison with two randomised anaesthetic techniques [J]. Eur J Anaesthesiol, 2015, 32(5):354-365.
24
Fraser GL, Riker RR. Bispectral index monitoring in the intensive care unit provides more signal than noise [J]. Pharmacotherapy, 2005, 25(5 Pt2):19S-27S.
25
赵玉洁,岳云,吴安石, 等. 熵指数和脑电双频谱指数在判断意识上的比较 [J]. 北京医学, 2013, 35(8):644-648.
26
张化,邸立超,吕慧敏, 等. 不同方法监测患者异丙酚镇静深度的准确性: BIS、Narcotrend指数、意识指数与听觉诱发电位指数的比较 [J]. 中华麻醉学杂志, 2015, 35(4):444-446.
27
Sharma A, Singh PM, Trikha A, et al. Entropy correlates with Richmond Agitation Sedation Scale in mechanically ventilated critically ill patients [J]. J Clin Monit Comput, 2014, 28(2):193-201.
28
Wager TD, Atlas LY, Lindquist MA, et al. An fMRI-based neurologic signature of physical pain [J]. N Engl J Med, 2013, 368(15):1388-1397.
[1] 涂鹏, 张晓航, 董虹美, 陈功立, 冉素真. 超声多普勒评估在双胎输血综合征射频消融减胎术后的应用价值[J]. 中华医学超声杂志(电子版), 2023, 20(05): 492-497.
[2] 徐娟, 孙汝贤, 赵东亚, 张清艳, 金兆辰, 蔡燕. 右美托咪定序贯镇静模式对中深度镇静的机械通气患者预后和谵妄的影响[J]. 中华危重症医学杂志(电子版), 2023, 16(05): 363-369.
[3] 姚咏明. 如何精准评估烧伤脓毒症患者免疫状态[J]. 中华损伤与修复杂志(电子版), 2023, 18(06): 552-552.
[4] 朴广昊, 李屹洲, 刘瑞, 赵建民, 王凌峰. 皮肤撕脱伤撕脱皮瓣活力早期评估与修复的研究进展[J]. 中华损伤与修复杂志(电子版), 2023, 18(06): 528-532.
[5] 高晋鸿, 郝少龙, 刘勇, 翁以炳, 韩威, 王冠, 张腾, 刘鹏, 张磊, 赵鑫宇. 腹腔镜阑尾切除术前应用吲哚美辛栓和氯诺昔康疗效的比较[J]. 中华普通外科学文献(电子版), 2023, 17(04): 293-297.
[6] 于智慧, 赵建军. 后路腰方肌阻滞复合全身麻醉在腹股沟斜疝经腹腹膜前手术中的应用效果[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 734-739.
[7] 田静, 方秀春. 超声引导下横筋膜平面阻滞在儿童腹股沟疝手术的应用效果[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 740-744.
[8] 王蕾, 王少华, 牛海珍, 尹腾飞. 儿童腹股沟疝围手术期风险预警干预[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 768-772.
[9] 双磊, 范宏瑾, 游兆媛. 日间疝外科手术病房护理评估记录单的改良和应用[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(05): 662-666.
[10] 黄铁刚, 肖凤霞. 地塞米松联合罗哌卡因在腹股沟疝修补术后镇痛效果及对血清指标的影响[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(05): 574-578.
[11] 谢文龙, 周建军. 超声引导下髂腹股沟-髂腹下神经阻滞联合腹横肌平面阻滞在老年腹股沟疝中的应用效果[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(05): 588-592.
[12] 段文忠, 白延霞, 徐文亭, 祁虹霞, 吕志坚. 七氟烷和丙泊酚在肝切除术中麻醉效果比较Meta分析[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 640-645.
[13] 王淑友, 宋晓晶, 贾术永, 王广军, 张维波. 肝脏去唾液酸糖蛋白受体靶向活体荧光成像评估酒精性肝损伤肝脏功能的研究[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 443-446.
[14] 徐洪宇, 何亚爽. 羟考酮与氢吗啡酮用于胃癌根治术后镇痛的疗效[J]. 中华消化病与影像杂志(电子版), 2023, 13(05): 312-316.
[15] 易成, 韦伟, 赵宇亮. 急性肾脏病的概念沿革[J]. 中华临床医师杂志(电子版), 2023, 17(08): 906-910.
阅读次数
全文


摘要