Expert consensus on analgesic management in severe adult patients in China

doi:10.3877/cma.j.issn.2096-1537.2023.02.001

Abstract

Subgroup of Critical Respiratory Diseases, China Clinical Practice Guideline Alliance. Expert consensus on analgesic management in severe adult patients in China[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2023, 09(02): 97-115.

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References 180

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阿片类药物	起效时间（min）	半衰期	负荷剂量	维持剂量	注意事项
吗啡	5~10	3~4 h	2～4 mg	2~30 mg/h	剂量蓄积可造成肝肾功能损伤；可引起组织胺释放
布托啡诺	1~2	4.7~5.8 h	5～10 mg	10~20 μg/min	有肝肾损伤的患者应减少初始剂量，随后的剂量依据患者反应调整；该药会增加肺血管阻力，增加心脏负担
芬太尼	1~2	2~4 h	0.35～0.5 μg/kg	0.7~10 μg/（kg•h）	剂量蓄积可造成肝功能损伤；不释放组胺；较之吗啡，更少出现低血压
瑞芬太尼	1~3	3~10 min	0.5～1 μg/kg， iv（＞1 min）	0.02~0.15 μg/（kg•min）	对肝肾功能无损害；若实际体质量＞130%理想体质量，使用理想体质量计算用量
舒芬太尼	1~3	13 h	0.2～0.5 μg/kg	0.2~0.3 μg/（kg•h）	剂量个体差异性较大，需个体化给药；该药分布半衰期短，代谢半衰期长，长期使用可能增加机械通气时间

阿片类药物	起效时间（min）	半衰期	负荷剂量	维持剂量	注意事项
吗啡	5~10	3~4 h	2～4 mg	2~30 mg/h	剂量蓄积可造成肝肾功能损伤；可引起组织胺释放
布托啡诺	1~2	4.7~5.8 h	5～10 mg	10~20 μg/min	有肝肾损伤的患者应减少初始剂量，随后的剂量依据患者反应调整；该药会增加肺血管阻力，增加心脏负担
芬太尼	1~2	2~4 h	0.35～0.5 μg/kg	0.7~10 μg/（kg•h）	剂量蓄积可造成肝功能损伤；不释放组胺；较之吗啡，更少出现低血压
瑞芬太尼	1~3	3~10 min	0.5～1 μg/kg， iv（＞1 min）	0.02~0.15 μg/（kg•min）	对肝肾功能无损害；若实际体质量＞130%理想体质量，使用理想体质量计算用量
舒芬太尼	1~3	13 h	0.2～0.5 μg/kg	0.2~0.3 μg/（kg•h）	剂量个体差异性较大，需个体化给药；该药分布半衰期短，代谢半衰期长，长期使用可能增加机械通气时间

（临床）问题	步骤1	步骤2	步骤3	步骤4	步骤5
（临床）问题	（等级1^*）	（等级2^*）	（等级3^*）	（等级4^*）	（等级5^*）
这个疾病有多普遍？（患病率）	当地的，当前的随机样本调查（或普查）	与当地情况相匹配调查的系统评价^**	当地的，非随机样本调查^**	病例系列^**	N/A
诊断或监测实验是否准确（诊断）	一致地应用了参考标准和盲法的横断面研究的系统评价	一致地应用了参考标准和盲法的横断面研究	非连续病例研究，或研究未能一致地应用参考标准^**	病例对照研究，或应用了差的或非独立的参考标准^**	基于机制的推理
若不给予这个治疗会发生什么？（预后）	起始队列研究的系统评价	起始队列研究	队列研究或随机研究的对照组^*	病例系列或病例对照研究，或低质量预后队列研究^**	N/A
这个治疗有用吗？（治疗效益）	随机试验或单病例随机对照试验的系统评价	随机试验或具有巨大效果的观察性研究	非随机对照队列/随访研究^**	病例系列，病例对照研究，或历史对照研究^**	基于机制的推理
这个治疗常见的伤害是什么（治疗伤害）	随机试验的系统评价，巢式病例对照研究的系统评价，针对你所提临床问题患者的n-of-1试验，具有巨大效果的观察性研究	单个随机试验或（特殊的）具有巨大效果的观察性研究	非随机对照队列/随访研究（上市后监测）提供，足够数量来排除常见的伤害（对长期伤害需要足够长的随访时间）^**	病例系列，病例对照研究，或历史对照研究^**	基于机制的推理
这个治疗少见的伤害是什么？（治疗伤害）	随机试验或n-of-1试验的系统评价	随机试验或（特殊的）具有巨大效果的观察性研究	—	—	—
这个实验（早期发现）值得吗？（筛查）	随机研究的系统评价	随机试验	非随机对照队列/随访研究^*	病例系列，病例对照研究，或历史对照研究^**	基于机制的推理

（临床）问题	步骤1	步骤2	步骤3	步骤4	步骤5
（临床）问题	（等级1^*）	（等级2^*）	（等级3^*）	（等级4^*）	（等级5^*）
这个疾病有多普遍？（患病率）	当地的，当前的随机样本调查（或普查）	与当地情况相匹配调查的系统评价^**	当地的，非随机样本调查^**	病例系列^**	N/A
诊断或监测实验是否准确（诊断）	一致地应用了参考标准和盲法的横断面研究的系统评价	一致地应用了参考标准和盲法的横断面研究	非连续病例研究，或研究未能一致地应用参考标准^**	病例对照研究，或应用了差的或非独立的参考标准^**	基于机制的推理
若不给予这个治疗会发生什么？（预后）	起始队列研究的系统评价	起始队列研究	队列研究或随机研究的对照组^*	病例系列或病例对照研究，或低质量预后队列研究^**	N/A
这个治疗有用吗？（治疗效益）	随机试验或单病例随机对照试验的系统评价	随机试验或具有巨大效果的观察性研究	非随机对照队列/随访研究^**	病例系列，病例对照研究，或历史对照研究^**	基于机制的推理
这个治疗常见的伤害是什么（治疗伤害）	随机试验的系统评价，巢式病例对照研究的系统评价，针对你所提临床问题患者的n-of-1试验，具有巨大效果的观察性研究	单个随机试验或（特殊的）具有巨大效果的观察性研究	非随机对照队列/随访研究（上市后监测）提供，足够数量来排除常见的伤害（对长期伤害需要足够长的随访时间）^**	病例系列，病例对照研究，或历史对照研究^**	基于机制的推理
这个治疗少见的伤害是什么？（治疗伤害）	随机试验或n-of-1试验的系统评价	随机试验或（特殊的）具有巨大效果的观察性研究	—	—	—
这个实验（早期发现）值得吗？（筛查）	随机研究的系统评价	随机试验	非随机对照队列/随访研究^*	病例系列，病例对照研究，或历史对照研究^**	基于机制的推理

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