休克病人的静镇痛治疗.ppt

总 结： 真的重要！ 恰当的浅镇静，有效镇痛 监测镇静相关的呼吸循环影响 推荐：休克早期复苏时选择 氯胺酮+咪唑安定 Thank you for your attention BACKGROUND:Anesthesia can become inadequate inadvertently or by misjudgment during surgery or emergence, and the surgical stress and pain stimulation will increase without adequate treatment. Overt stimulation may activate the sympathetic nervous system, increase the blood level of catecholamines, and lead to splanchnic arterial vasoconstriction. Dexmedetomidine prevents alterations of intestinal microcirculation that are induced by surgical stress and pain in a novel rat model. Yeh YC, Anesth Analg. 2012 Jul;115(1):46-53. Epub 2012 Apr 13. 30 Wistar rats dividedinto the following 3 groups: control, surgical stress and pain (SSP), and surgical stress and pain + Dex (SSP + Dex). Yeh YC, Anesth Analg. 2012 Jul;115(1):46-53. Epub 2012 Apr 13. Using this rat model (surgical stress and pain stimulation on the intestinal microcirculation) , we found that dexmedetomidine can normalize global hemodynamics and prevent the alteration of intestinal microcirculation. Conclusion Yeh YC, Anesth Analg. 2012 Jul;115(1):46-53. Epub 2012 Apr 13. Sedation attenuated TNFα production . Crit Care 2009, 13:R136 Sedation improves early outcome in severely septic rats . Crit Care 2009, 13:R136 恰当的镇痛镇静可改善组织灌注. 有些我们看得见，有些看不见，但存在！ 镇痛镇静对组织灌注的影响有多大 降低患者的焦虑应激 改善组织灌注 减少继发性损害 诱发严重低血压，导致器官损伤。 镇静/镇痛控制应激与血管张力 病 例 男性，64岁，强体力劳动后发热1周， T: 38.5 -40 C°，伴咳嗽、咳黄痰、胸疼。 接受抗感染治疗（用药不详）无效。 加重伴气短、呼吸困难1天入急诊抢救室。 既往体健 血压 100/60 mm Hg、心率 145 次/分， 呼吸 38 次/分, 无哮鸣音，右下肺细湿啰音，左下肺呼吸音低， 血气分析：pH 7.48， PaCO2 31 mm Hg，PaO2 45 mm Hg（氧流量=4 L/min ）， 生化检查：Lac 4.1 mmol/L，余正常。 气管插管， 机械通气。 芬太尼0.05mg，propofol 50 mg IV。 3min 后 血压 65/45 mm Hg、心率 105 次/分， 60min 后 生化检查：Lac 6.5 mmol/L。 镇静/镇痛深度与低血压的发生 深镇静/镇痛易诱发严重低血压。 Rats were randomly received normal saline (1 mL/h), 1 mg/kg/hr or 10 mg/kg/hr propofol after haemorrhagic shock. (NS1 mL/h), 1 mg/kg/hr or 10 mg/kg/hr Clin Exp Pharm Physiol (20