机械通气时冷静药物使用.ppt

机械通气的镇静;ICU中约有70％的病人存在焦虑，50％病人经历烦躁,特别是机械通气的患者.;焦虑或烦躁导致的并发症;理想镇静剂的特点;常用镇静药物;1-苯二氮卓类(BNZs) ;BNZs 可以口服、肌肉注射及静脉注射 为脂溶性药物，对低蛋白血症患者，易使血中游离药物浓度升高，与其他高蛋白结合率药物相互影响 经过肝脏代谢和排除 长期用药后停药，可产生生理和心理的依赖，发生戒断综合症 血中结合形式的 BNZs 不能通过透析清除 ;2-异丙酚(Propofol) ;副作用;有资料表明应用异丙酚镇静可以缩短烧伤及创伤病人、合并有多器官功能衰竭的病人以及心脏手术病人的机械通气和在ICU停留时间。虽然应用异丙酚的费用要高于咪唑安定，但如果采用“三明治”方案，即开始和停止镇静前应用异丙酚，在中间用咪唑安定的复合用药方案可提供相似的有效镇静而减少异丙酚的用量，从而降低费用。;EDTA丙泊酚降低病人的死亡率的机制：对烧伤病人其免疫调节作用是重要因素之一，这种作用也有助于消除与多器官功能衰竭有关的全身炎症反应。 EDTA还具有调节细胞活性的功能，特别是对锌和铁等重金属的螯合作用。 ;Desired level of sedation;Speed of recovery after sedation;3-肾上腺素能α2受体激动剂;4-精神类安定剂;Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.;镇静深度的分类;镇静评分; Recommendations: A sedation goal or endpoint should be established and regularly redefined for each patient. Regular assessment and response to therapy should be systematically documented. (Grade C) ;主观评分;Ramsay标准评分;镇静—激动评分(SAS);Brussels 镇静评分;RecommendationS： The use of a validated sedation assessment scale (SAS, MAAS, or VICS) is recommended. (Grade B) ;客观评分;BIS;BIS的四个特征; Recommendations： Objective measures of sedation, such as BIS, have not been completely evaluated and are not yet proven useful in the ICU. (Grade C) ;Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.;机械通气哮喘患者的特殊镇静 ;机械通气患者的间断镇静与持续镇静; 观察结果： 间断镇静治疗模式可显著缩短机械通气时间(7.3d比4.9d) 减少在ICU的停留时间(9.9d比6.4d) 缩短住院天数(16.9d比13.3d)。;Figure 1. Kaplan–Meier Analysis of the Duration of Mechanical Ventilation, (relative risk of extubation, 1.9; 95 percent confidence interval, 1.3 to 2.7; P0.001).;Figure 2. Kaplan–Meier Analysis of the Length of Stay in the Intensive Care Unit (ICU), (relative risk of discharge, 1.6; 95 percent confidence interval, 1.1 to 2.3; P=0.02).;Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.;镇静镇痛药物的撤离; Recommendation: The potential for opioid, benzodiazepine, and