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中华重症医学电子杂志 ›› 2017, Vol. 03 ›› Issue (04) : 262 -265. doi: 10.3877/cma.j.issn.2096-1537.2017.04.006

所属专题: 镇痛镇静 重症医学 文献

专题笔谈

ICU镇痛镇静药物的合理使用
蒋良艳1, 汤展宏1,()   
  1. 1. 530021 南宁,广西医科大学第一附属医院重症医学科
  • 收稿日期:2017-05-10 出版日期:2017-11-28
  • 通信作者: 汤展宏
  • 基金资助:
    中华医学会临床医学专项资金项目(13091510536)

Rational application of analgesic and sedative in intensive care unit

Liangyan Jiang1, Zhanhong Tang1,()   

  1. 1. Department of ICU, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
  • Received:2017-05-10 Published:2017-11-28
  • Corresponding author: Zhanhong Tang
  • About author:
    Corresponding author: Tang Zhanhong; Email:
引用本文:

蒋良艳, 汤展宏. ICU镇痛镇静药物的合理使用[J]. 中华重症医学电子杂志, 2017, 03(04): 262-265.

Liangyan Jiang, Zhanhong Tang. Rational application of analgesic and sedative in intensive care unit[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2017, 03(04): 262-265.

镇痛镇静已成为ICU常规治疗的一部分。合理的镇痛镇静原则应以患者为中心,以疾病为导向,掌握镇痛镇静药物的药理学特征,在充分镇痛的基础上,个体化选择最小的镇静,使患者达到最佳的状态。阿片类药物是ICU患者治疗非神经源性疼痛的首选药物,多模式组合及联合用药可减少阿片类药物的使用剂量和不良反应。苯二氮卓类药物是引起ICU谵妄的独立危险因素,故ICU镇静常规选用短效、易滴定的丙泊酚及右美托咪定。对特殊情况如程序性镇静的遗忘,癫痫发作,酒精及苯二氮卓类药物戒断,明显焦虑、躁动以及需要深度镇静、联合用药时,苯二氮卓类药物仍发挥重要的作用。如何更合理使用镇痛镇静药物仍需更进一步的深入研究。

Analgesia and sedation are common clinical practices in intensive care unit. Approprite analgesia and sedation should be patient-oriented and disease-oriented. Understand the pharmacological characteristics of analgesic and sedative, individual light sedation on the basis of adequate analgesia to make the patient achieve the best condition. Opioids are considered the first-line drug class of choice to treat non-neuropathic pain in critically ill patients. Combine strategy can reduce total opioid dosage and avoid adverse effects. Benzodiazepines exposure is an independent risk factors for ICU delirium. Therefore, short-acting, easy-to-titrate agents such as propofol and dexmedetomidine were selected as the first line choice. Benzodiazepines should be reserved for specific indications, such as procedural sedation, seizures, alcohol and benzodiazepine withdrawal, apparent anxiety,agitation and deep sedation. Further research on how to rational application of analgesic and sedative is needed.

1
Skrobik Y, Chanques G. The pain, agitation, and delirium practice guidelines for adult critically ill patients: a post-publication perspective [J]. Ann Intensive Care, 2013, 3(1):9.
2
Erstad BL, Puntillo K, Gilbert HC, et al. Pain management principles in the critically ill [J]. Chest, 2009, 135(4):1075-1086.
3
Chanques G, Sebbane M, Barbotte E, et al. A prospective study of pain at rest: incidence and characteristics of an unrecognized symptomin surgical and trauma versus medical intensive care unit patients [J]. Anesthesiology, 2007, 7(5):858-860.
4
Reade MC, Finfer S. Sedation and delirium in the intensive care unit [J]. N Engl J Med, 2014, 370(5):444-454.
5
Vincent JL, Shehabi Y, Walsh TS, et al. Comfort and patient-centred care without excessive sedation: the eCASH concept [J]. Intensive Care Med, 2016, 42(6):962-971.
6
Shapiro BA, Warren J, Egol AB, et al. Practice parameters for intravenous analgesia and sedation for adult patients in the intensive care unit: an executive summary. Society of Critical Care Medicine [J]. Crit Care Med, 1995, 23(9):1596-1600.
7
Jacobi J, Fraser GL, Coursin DB, et al. Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult [J]. Crit Care Med, 2002, 30(1):119-141.
8
Barr J, Fraser GL, Puntillo K, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patientsin the intensive care unit [J]. Crit Care Med, 2013, 41(1):263-306.
9
Baron R, Binder A, Biniek R, et al. Evidence and consensus based guideline for the management of delirium, analgesia, and sedation in intensive care medicine. Revision 2015 (DAS-Guideline 2015) - short version [J]. Ger Med Sci, 2015, 13:Doc19.
10
Kohler M, Chiu F, Gelber KM, et al. Pain management in critically ill patients: a review of multimodal treatment options [J]. Pain Manag, 2016, 6(6):591-602.
11
Ehieli E, Yalamuri S, Brudney CS, et al. Analgesia in the surgical intensive care unit [J]. Postgrad Med J, 2017, 93(1095):38-45.
12
Richards-Belle A, Canter RR, Power GS, et al. National survey and point prevalence study of sedation practice in UK critical care [J]. Crit Care, 2016, 20(1):355.
13
Muellejans B, López A, Cross MH, et al. Remifentanil versus fentanyl for analgesia based sedation to provide patient comfort in the intensive care unit: a randomized, double-blind controlled trial [ISRCTN43755713] [J]. Crit Care, 2004, 8(1):R1-R11.
14
McNicol ED, Tzortzopoulou A, Cepeda MS, et al. Single-dose intravenous paracetamol or propacetamol for prevention or treatment ofpostoperative pain: a systematic review and meta-analysis [J]. Br J Anaesth, 2011, 106(6):764-775.
15
Dahl JB, Nielsen RV, Wetterslev J, et al. Post-operative analgesic effects of paracetamol, NSAIDs, glucocorticoids, gabapentinoids and their combinations: a topical review [J]. Acta Anaesthesiol Scand, 2014, 58(10):1165-1181.
16
Loftus RW, Yeager MP, Clark JA, et al. Intraoperative ketamine reduces perioperative opiate consumption in opiate-dependent patients with chronic back pain undergoing back surgery [J]. Anesthesiology, 2010, 113(3):639-646.
17
McGuinness SK, Wasiak J, Cleland H, et al. A systematic review of ketamine as an analgesic agent in adult burn injuries [J]. Pain Med, 2011, 12(10):1551-1558.
18
Roberts DJ, Haroon B, Hall RI. Sedation for critically ill or injured adults in the intensive care unit: a shifting paradigm [J]. Drugs, 2012, 72(14):1881-1916.
19
Barends CR, Absalom A, van Minnen B, et al. Dexmedetomidine versus Midazolam in Procedural Sedation. A Systematic Review of Efficacy and Safety [J]. PLoS One, 2017, 12(1):e0169525.
20
Jakob SM, Ruokonen E, Grounds RM, et al. Dexmedetomidine vs midazolam or propofol for sedation during prolonged mechanical ventilation: two randomized controlled trials [J]. JAMA, 2012, 307(11):1151-1160.
21
Kawazoe Y, Miyamoto K, Morimoto T, et al. Effect of Dexmedetomidine on Mortality and Ventilator-Free Days in Patients Requiring Mechanical Ventilation With Sepsis: A Randomized Clinical Trial [J]. JAMA, 2017, 317(13):1321-1328.
22
Zhang Z, Chen K, Ni H, et al. Sedation of mechanically ventilated adults in intensive care unit: a network meta-analysis [J]. Sci Rep, 2017, 7:44979.
23
Su X, Meng ZT, Wu XH, et al. Dexmedetomidine for prevention of delirium in elderly patients after non-cardiac surgery: a randomised, double-blind, placebo-controlled trial [J]. Lancet, 2016, 388(10054):1893-1902.
24
Conti G, Ranieri VM, Costa R, et al. Effects of dexmedetomidine and propofol on patient-ventilator interaction in difficult-to-wean, mechanically ventilated patients: a prospective, open-label, randomised, multicentre study [J]. Crit Care, 2016, 20(1):206.
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