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) : 296 -300. doi: 10.3877/cma.j.issn.2096-1537.2017.04.013

所属专题: 镇痛镇静 文献

综述

颅脑损伤患者镇痛镇静治疗的临床应用进展
王翠婷1, 杨翃1,()   
  1. 1. 510630 广州,南方医科大学第三附属医院重症医学科
  • 收稿日期:2017-03-18 出版日期:2017-11-28
  • 通信作者: 杨翃

Advance in clinical management of analgesia and sedation in patients with craniocerebral injury

Cuiting Wang1, Hong Yang1,()   

  1. 1. Department of Critical Care Medicine, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China
  • Received:2017-03-18 Published:2017-11-28
  • Corresponding author: Hong Yang
  • About author:
    Corresponding author: Yang Hong, Email:
引用本文:

王翠婷, 杨翃. 颅脑损伤患者镇痛镇静治疗的临床应用进展[J/OL]. 中华重症医学电子杂志, 2017, 03(04): 296-300.

Cuiting Wang, Hong Yang. Advance in clinical management of analgesia and sedation in patients with craniocerebral injury[J/OL]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2017, 03(04): 296-300.

在神经重症监护室,手术创伤及大量有创诊疗操作均可引起患者疼痛、躁动和兴奋,导致血压增高、心率增快,这些都会增加再出血、颅内压增高、导管脱落和误伤等风险。镇痛镇静治疗具有脑保护作用,能有效减轻患者的疼痛及身体不适感,减少应激,降低脑代谢,防止因疼痛引起的颅内压和血压增高。本文就颅脑损伤患者的镇痛镇静治疗作一综述。

In the neuro-intensive care unit, the surgical strikes and numerous invasive procedures make patients feel pain, agitation and activation, which results in hypertension and increased heart rates. This will increase the risk of rebleeding, intracranial hypertension, unexpectedly extubation, accidentally injures and so on. Sedation and analgesia play a critical role in protecting brain through pain and discomfort relieve, decreasing the stress and reducing brain metabolism to prevent intracranial hypertension and hypertension. We will review the impact of the therapy of analgesia and sedation in patients with craniocerebral injury in this paper.

1
中国医师协会神经外科医师分会神经重症专家委员会. 重症脑损伤患者镇痛镇静治疗专家共识 [J]. 中国脑血管病杂志, 2014(1):48-55.
2
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.
3
中华医学会重症医学分会. 中国重症加强医疗病房患者镇痛和镇静治疗指导意见(2006) [J]. 中华外科杂志, 2006, 44(17):1158-1166.
4
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.
5
Gremmelt A, Braun U. Analgesia and sedation in patients with head-brain trauma [J]. Anaesthesist, 1995, 44 (Suppl 3):S559-S565.
6
Wahlström MR, Olivecrona M, Koskinen LO, et al. Severe traumatic brain injury in pediatric patients: treatment and outcome using an intracranial pressure targeted therapy--the Lund concept [J]. Intensive Care Med, 2005, 31(6):832-839.
7
Naredi S, Edén E, Zäll S, et al. A standardized neurosurgical neurointensive therapy directed toward vasogenic edema after severe traumatic brain injury: clinical results [J]. Intensive Care Med, 1998, 24(5):446-451.
8
王巍,胡东东,王玲, 等. 不同镇静药物对轻中度颅脑损伤镇静效果的比较研究 [J]. 临床神经外科杂志, 2015, 7(6):464-466.
9
邱海波. 重症患者的镇痛和镇静: 以疾病为导向 [J]. 中华内科杂志, 2013, 52(4):279-281.
10
Mckee AC, Daneshvar DH. The neuropathology of traumatic brain injury [J]. Handb Clin Neurol, 2015, 127:45-66.
11
Jauch EC, Lindsell CJ, Adeoye O, et al. Lack of evidence for an association between hemodynamic variables and hematoma growth in spontaneous intracerebral hemorrhage [J]. Stroke, 2006, 37(8):2061-2065.
12
Balestreri M, Czosnyka M, Chatfield DA, et al. Predictive value of Glasgow Coma Scale after brain trauma: change in trend over the past ten years [J]. J Neurol Neurosurg Psychiatry, 2004, 75(1):161-162.
13
Stocchetti N, Pagan F, Calappi E, et al. Inaccurate early assessment of neurological severity in head injury [J]. J Neurotrauma, 2004, 21(9):1131-1140.
14
Kochanek PM, Carney N, Adelson PD, et al. Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents--second edition [J]. Pediatr Crit Care Med, 2012, 13(Suppl 1):S1-S82.
15
Hughes A, Lee C, Kirkham F, et al. Delayed extradural haemorrhage: a case for intracranial pressure monitoring in sedated children with traumatic brain injury within tertiary centres [J]. BMJ Case Rep, 2013, 2013.
16
Maas AI, Stocchetti N, Bullock R. Moderate and severe traumatic brain injury in adults [J]. Lancet Neurol, 2008, 7(8):728-741.
17
Stiefel MF, Spiotta A, Gracias VH, et al. Reduced mortality rate in patients with severe traumatic brain injury treated with brain tissue oxygen monitoring [J]. J Neurosurg, 2005, 103(5):805-811.
18
Suehiro E, Koizumi H, Fujiyama Y, et al. Predictors of deterioration indicating a requirement for surgery in mild to moderate traumatic brain injury [J]. Clin Neurol Neurosurg, 2014, 127:97-100.
19
尹培刚,黄勇,吴琨, 等. 首次全国ICU现状调查分析 [J]. 中华危重病急救医学, 2002, 14(3):166-168.
20
De Jonghe B, Bastuji-Garin S, Fangio P, et al. Sedation algorithm in critically ill patients without acute brain injury [J]. Crit Care Med, 2005, 33(1):120-127.
21
Li M, Zhang Y, Wu KS, et al. Assessment of the effect of continuous sedation with mechanical ventilation on adrenal insufficiency in patients with traumatic brain injury [J]. J Investig Med, 2016, 64(3):752-758.
22
Shehabi Y, Bellomo R, Reade MC, et al. Early intensive care sedation predicts long-term mortality in ventilated critically ill patients [J]. Am J Respir Crit Care Med, 2012, 186(8):724-731.
23
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.
24
Skoglund K, Enblad P, Hillered L, et al. The neurological wake-up test increases stress hormone levels in patients with severe traumatic brain injury [J]. Crit Care Med, 2012, 40(1):216-222.
25
Shehabi Y, Bellomo R, Reade MC, et al. Early goal-directed sedation versus standard sedation in mechanically ventilated critically illpatients: a pilot study [J]. Crit Care Med, 2013, 41(8):1983-1991.
26
Dahaba AA, Grabner T, Rehak PH, et al. Remifentanil versus morphine analgesia and sedation for mechanically ventilated critically ill patients: a randomized double blind study [J]. Anesthesiology, 2004, 101(3):640-646.
27
Cavaliere F, Antonelli M, Arcangeli A, et al. A low-dose remifentanil infusion is well tolerated for sedation in mechanically ventilated, critically-ill patients [J]. Can J Anaesth, 2002, 49(10):1088-1094.
28
Leone M, Albanèse J, Viviand X, et al. The effects of remifentanil on endotracheal suctioning-induced increases in intracranial pressure in head-injured patients [J]. Anesth Analg, 2004, 99(4):1193-1198
29
Karabinis A, Mandragos K, Stergiopoulos S, et al. Safety and efficacy of analgesia-based sedation with remifentanil versus standard hypnotic-based regimens in intensive care unit patients with brain injuries: a randomised, controlled trial [ISRCTN50308308] [J]. Crit Care, 2004, 8(4):R268-R280.
30
Skoglund K, Enblad P, Marklund N. Monitoring and sedation differences in the management of severe head injury and subarachnoid hemorrhage among neurocritical care centers [J]. J Neurosci Nurs, 2013, 45(6):360-368.
31
Roberts DJ, Hall RI, Kramer AH, et al. Sedation for critically ill adults with severe traumatic brain injury: a systematic review of randomized controlled trials [J]. Crit Care Med, 2011, 39(12):2743-2751.
32
Sanders RD, Maze M. Contribution of sedative-hypnotic agents to delirium via modulation of the sleep pathway [J]. Can J Anaesth, 2011, 58(2):149-156.
33
Zaal IJ, Slooter AJ. Delirium in critically ill patients: epidemiology, pathophysiology, diagnosis and management [J]. Drugs, 2012, 72(11):1457-1471.
34
Coull JT, Jones ME, Egan TD, et al. Attentional effects of noradrenaline vary with arousal level: selective activation of thalamic pulvinar in humans [J]. Neuroimage, 2004, 22(1):315-322.
35
Aryan HE, Box KW, Ibrahim D, et al. Safety and efficacy of dexmedetomidine in neurosurgical patients [J]. Brain Inj, 2006, 20(8):791-798.
36
Yokota H, Yokoyama K, Noguchi H, et al. Post-operative dexmedetomidine-based sedation after uneventful intracranial surgery for unruptured cerebral aneurysm: comparison with propofol-based sedation [J]. Neurocrit Care, 2011, 14(2):182-187.
37
Grof TM, Bledsoe KA. Evaluating the use of dexmedetomidine in neurocritical care patients [J]. Neurocrit Care, 2010, 12(3):356-361.
38
Tsaousi GG, Lamperti M, Bilotta F. Role of Dexmedetomidine for Sedation in Neurocritical Care Patients: A Qualitative Systematic Review and Meta-analysis of Current Evidence [J]. Clin Neuropharmacol, 2016, 39(3):144-151.
39
White PF, Way WL, Trevor AJ. Ketamine--its pharmacology and therapeutic uses [J]. Anesthesiology, 1982, 56(2):119-136.
40
Zeiler FA, Teitelbaum J, West M, et al. The ketamine effect on intracranial pressure in nontraumatic neurological illness [J]. J Crit Care, 2014, 29(6):1096-1106.
41
Bourgoin A, Albanèse J, Wereszczynski N, et al. Safety of sedation with ketamine in severe head injury patients: comparison with sufentanil [J]. Crit Care Med, 2003, 31(3):711-717.
42
Himmelseher S, Durieux ME. Revising a dogma: ketamine for patients with neurological injury? [J]. Anesth Analg, 2005, 101(2):524-534.
43
衣玉胜,殷积慧. 氯胺酮脑保护作用研究进展 [J]. 中国康复理论与实践, 2007, 13(3):205-207.
[1] 许亚龙, 巩栋, 陈晓涛. 超前镇痛在全膝关节置换术中的研究进展[J/OL]. 中华关节外科杂志(电子版), 2024, 18(04): 517-523.
[2] 代莉, 郭华静, 邓恢伟. 镇痛-伤害性刺激指数指导下无阿片类药物麻醉对腔镜下甲状腺手术患者术后恢复质量的影响[J/OL]. 中华普通外科学文献(电子版), 2024, 18(04): 282-286.
[3] 方辉强, 黄杰, 随冰琰. 腰方肌阻滞与腹横肌平面阻滞对腹股沟疝腹腔镜手术患者术后镇痛效果的影响[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 697-702.
[4] 韦雅丽, 范利杰. 术前右美托咪定滴鼻在腹股沟斜疝患儿腹腔镜下疝囊高位结扎术中的应用[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(04): 446-450.
[5] 王守森, 傅世龙, 鲜亮, 林珑. 深入理解控制性减压技术对创伤性颅脑损伤术中脑膨出的预防机制与效果[J/OL]. 中华神经创伤外科电子杂志, 2024, 10(05): 257-262.
[6] 吴东阳, 林向丹, 石佐林, 赵玉龙, 王振, 文安国, 纪鑫, 李俊之, 赵明光. NF-L、NLRP3、S100B 蛋白在颅脑损伤严重程度及预后评估中的应用价值[J/OL]. 中华神经创伤外科电子杂志, 2024, 10(05): 279-285.
[7] 罗磊, 熊建平, 郑宏伟, 王嗣嵩, 柴祥, 吴青, 潘海鹏. 静脉留置针穿刺引流治疗颅骨修补术后硬膜外积液一例报道[J/OL]. 中华神经创伤外科电子杂志, 2024, 10(05): 315-317.
[8] 从长春, 王春琳, 武孝刚, 王金标, 章福彬, 孙磊, 王李. 重型颅脑损伤患者呼吸机相关性肺炎的危险因素及病原学分析[J/OL]. 中华神经创伤外科电子杂志, 2024, 10(03): 151-157.
[9] 毛进鹏, 陶治鹤, 刘琦, 王勇, 周明安, 陈劲松, 田少斌. 保守治疗大量创伤性硬膜外血肿的体会(附10例报告)[J/OL]. 中华神经创伤外科电子杂志, 2024, 10(03): 164-168.
[10] 辛强, 朱文豪, 何川, 李文臣, 陈勃, 王海峰. 神经胶质细胞来源的外泌体miRNAs对创伤性颅脑损伤后神经炎症的影响[J/OL]. 中华神经创伤外科电子杂志, 2024, 10(03): 169-173.
[11] 苗明月, 周建新. 肺保护性镇静:应重视呼吸驱动和吸气努力的床旁评估[J/OL]. 中华重症医学电子杂志, 2024, 10(04): 325-328.
[12] 唐韵, 杨小博, 余愿, 舒化青, 尚游. 苯磺酸瑞马唑仑的临床研究进展[J/OL]. 中华重症医学电子杂志, 2024, 10(04): 389-393.
[13] 胡志恒, 任洪波, 宋志远, 张运刚, 韩晓正. 血清sTIM-3及其配体Gal-9、CEACAM-1与创伤性颅脑损伤患者脑损伤程度及预后的关系[J/OL]. 中华脑科疾病与康复杂志(电子版), 2024, 14(04): 201-207.
[14] 张平骥, 徐钰, 李天水, 庞文翼, 符师宁, 张梦圆. 重症患者镇静治疗现状及期望的调查研究[J/OL]. 中华临床医师杂志(电子版), 2024, 18(06): 562-567.
[15] 王文珠, 刘建, 袁常秀, 石亚飞, 尤培军. 竖脊肌平面阻滞对非体外循环冠状动脉旁路移植术中阿片类药物用量的影响[J/OL]. 中华诊断学电子杂志, 2024, 12(03): 155-159.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?