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中华重症医学电子杂志

中华重症医学电子杂志 ›› 2019, Vol. 05 ›› Issue (04) : 353 -358. doi: 10.3877/cma.j.issn.2096-1537.2019.04.011

所属专题： 镇痛镇静； 中国重症基层诊疗流程； 指南规范； 文献；

基层诊疗流程

重症患者镇痛、镇静与谵妄诊治流程
陈敏英1, 胡波2, 张丽娜3, 郑瑞强4, 翟茜5, 杨向红6, 虞文魁7, 王洪亮8, 隆云9,†(), 重症基层诊疗协作组   
  1. 1. 510080　广州，中山大学附属第一医院重症医学科
    2. 430071　武汉，武汉大学中南医院重症医学科
    3. 410008　长沙，中南大学湘雅医院重症医学科
    4. 225001　扬州，苏北人民医院重症医学科
    5. 250012　济南，山东大学齐鲁医院重症医学科
    6. 310014　杭州，浙江省人民医院重症医学科
    7. 210008　南京大学医学院附属鼓楼医院重症医学科
    8. 150081　哈尔滨，哈尔滨医科大学附属第二医院重症医学科
    9. 100730　北京，中国医学科学院　北京协和医学院　北京协和医院重症医学科
  • 收稿日期:2019-01-24 出版日期:2019-11-28
  • 通信作者: 隆云
  • 基金资助:
    广东省科技创新战略专项资金项目(2018YJ026)

Protocolized treatment for pain, agitation, and delirium in critically ill patients

Minying Chen1, Bo Hu2, Lina Zhang3, Ruiqiang Zheng4, Qian Zhai5, Xianghong Yang6, Wenkui Yu7, Hongliang Wang8, Yun Long9,†(), Critical Care County Working Group   

  1. 1. Department of Critical Care Medicine, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
    2. Department of Intensive Care Unit, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
    3. Department of Intensive Care Unit, Xiangya Hospital, Central South University, Changsha 410008, China
    4. Department of Critical Care Medicine, Northern Jiangsu Province People′s Hospital, Yangzhou 225001, China
    5. Department of Critical Care Medicine, Qilu Hospital of Shandong University, Jinan 250012, China
    6. Department of Critical Care Medicine, Zhejiang Provincial People′s Hospital, Hangzhou 310014, China
    7. Department of Critical Care Medicine, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
    8. Department of Critical Care Medicine, Second Affiliated Hospital of Harbin Medical University, Harbin 150081, China
    9. Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
  • Received:2019-01-24 Published:2019-11-28
  • Corresponding author: Yun Long
  • About author:
    Corresponding author: Long Yun, Email:
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引用本文：

陈敏英, 胡波, 张丽娜, 郑瑞强, 翟茜, 杨向红, 虞文魁, 王洪亮, 隆云, 重症基层诊疗协作组. 重症患者镇痛、镇静与谵妄诊治流程[J]. 中华重症医学电子杂志, 2019, 05(04): 353-358.

Minying Chen, Bo Hu, Lina Zhang, Ruiqiang Zheng, Qian Zhai, Xianghong Yang, Wenkui Yu, Hongliang Wang, Yun Long, Critical Care County Working Group. Protocolized treatment for pain, agitation, and delirium in critically ill patients[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2019, 05(04): 353-358.

疼痛和焦虑情绪对重症医学科（ICU）患者造成严重心理应激，甚至影响患者预后。恰当的镇痛镇静治疗可以缓解疼痛及不适感，降低谵妄发生风险，实现器官功能保护。ICU镇痛镇静治疗需秉承先评估后治疗、先镇痛后镇静的原则，进行镇痛镇静治疗时必须注重使用非药物性措施改善患者的舒适性。因此制订完整、简洁的流程有助于镇痛镇静治疗实施，达到良好的镇痛镇静效果。

关键词: 镇痛, 镇静, 谵妄, 重症医学科

Pain and anxiety cause severe psychological stress and badly affect the outcome in intensive care unit (ICU) patients. Appropriate analgesia and sedation can meliorate pain and discomfort, reduce the risk of delirium and achieve the goal of organ protection. We must follow the sequence of assessment, analgesia and sedation. We also need to pay attention to non-pharmacologic interventions during analgesia and sedation. Setting up a complete and concise protocol can improve analgesia and sedation.

Key words: Analgesia, Sedation, Delirium, Intensive care unit
图1 重症患者镇痛、镇静与谵妄诊疗流程
1
Devlin JW, Skrobik Y, Gélinas C, et al. Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU [J]. Crit Care Med, 2018, 46(9):e825-e873.
2
中华医学会重症医学分会. 中国成人ICU镇痛和镇静治疗指南[J/OL].中华重症医学电子杂志, 2018, 4(2): 90-113.
3
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.
4
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.
5
Yu EH, Tran DH, Lam SW, et al. Remifentanil tolerance and hyperalgesia: short-term gain, long-term pain? [J]. Anaesthesia, 2016, 71(11): 1347-1362.
6
Shetty RM, Bellini A, Wijayatilake DS, et al. BIS monitoring versus clinical assessment for sedation in mechanically ventilated adults in the intensive care unit and its impact on clinical outcomes and resource utilization [J]. Cochrane Database Syst Rev, 2018, 2: CD011240.
7
Kotani Y, Shimazawa M, Yoshimura S, et al. The experimental and clinical pharmacology of propofol, an anesthetic agent with neuroprotective properties [J]. CNS Neurosci Ther, 2008, 14(2): 95-106.
8
Swan JT, Fitousis K, Hall JB, et al. Antipsychotic use and diagnosis of delirium in the intensive care unit [J]. Crit Care, 2012, 16(3): R84.
9
Zaal IJ, Devlin JW, Peelen LM, et al. A systematic review of risk factors for delirium in the ICU [J]. Crit Care Med, 2015, 43(1): 40-47.
10
Santos E, Cardoso D, Neves H, et al. Effectiveness of haloperidol prophylaxis in critically ill patients with a high risk of delirium: a systematic review [J]. JBI Database System Rev Implement Rep, 2017, 15(5): 1440-1472.
11
Neufeld KJ, Yue J, Robinson TN, et al. Antipsychotic medication for prevention and treatment of delirium in hospitalized adults: A systematic review and Meta-analysis [J]. J Am Geriatr Soc, 2016, 64(4): 705-714.
12
Serafim RB, Bozza FA, Soares M, et al. Pharmacologic prevention and treatment of delirium in intensive care patients: A systematic review [J]. J Crit Care, 2015, 30(4): 799-807.
13
Mo Y, Yam FK. Rational use of second-generation antipsychotics for the treatment of ICU delirium [J]. J Pharm Pract, 2017, 30(1): 121-129.
14
Pisani MA, Friese RS, Gehlbach BK, et al. Sleep in the intensive care unit [J]. Am J Respir Crit Care Med, 2015, 191(7): 731-738.
15
Boyko Y, Jennum P, Nikolic M, et al. Sleep in intensive care unit: the role of environment [J]. J Crit Care, 2017, 37: 99-105.
16
Patel J, Baldwin J, Bunting P, et al. The effect of a multicomponent multidisciplinary bundle of interventions on sleep and delirium in medical and surgical intensive care patients [J]. Anaesthesia, 2014, 69(6): 540-549.
17
Dammeyer J, Dickinson S, Packard D, et al. Building a protocol to guide mobility in the ICU [J]. Crit Care Nurs Q, 2013, 36(1): 37-49.
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