ICU病人镇静与镇痛课件.ppt

*ICU病人镇静与镇痛yurongguoTheFineBalanceinPatientComfort*ICU病人镇静与镇痛yurongguo镇静镇痛要遵循Master原则！*ICU病人镇静与镇痛yurongguoPharmacologicAgentsCurrentlyUsedforICUSedationOpioids阿片类Morphine吗啡Fentanyl芬太尼Lorazepam氯硝安定Midzolam咪唑安定Propofol异丙酚Benzodiazepines苯二氮卓类Sedative/hypnotics镇静／催眠类*ICU病人镇静与镇痛yurongguoOpioids:ClinicalEffectsAnalgesiaAddstosedationToleranceRespiratorydepressionWithdrawalsymptomsHypotensionBradycardiaConstipation*ICU病人镇静与镇痛yurongguoBenzodiazepines苯二氮卓类@MidazolamRapidonsetHypotensioneffectsProlongedrecoveryafterlongtermuseOpioidcombinationincreasehypotension@LorazepamSloweronsetPropyleneglycoltoxicityLesshypotensionCompatibilityissuesPreferredforprolongedsedation*ICU病人镇静与镇痛yurongguoNotwellunderstandGABA_AreceptormodulationismostlikelyPropofol:MechanismsofAction*ICU病人镇静与镇痛yurongguoPropofol:ClinicalEffectsAnesthesiaandsedationRapidonsetofactionShorthalf-lifeDecreaseinBPHRDecreaseventilationTimetoextubationfasterthenwithmidazolam麻醉诱导与镇静起效快作用时间短循环抑制呼吸抑制脱机拔管时间短Ostermannetal.JAMA.2000;283:1457*ICU病人镇静与镇痛yurongguoPropofolAdvantages镇静Sedation催眠Hypnosis缓解焦虑Anxiolysis遗忘Amnesia肌松Musclerelaxation降低颅内压ICP降低代谢CMRO2解除气道痉挛ReliefofbronchospasmLimitations收缩力下降Decreasedcontractility无镇痛作用Lackofanalgesiceffect呼吸抑制Respiratorydepression低血压Hypotension高脂血症Hypertriglyceridemia防腐剂问题Preservativeissues代酸Acidosis潜在相关性导管感染Potentialofinfectionnecessitatesneedforregularchangingoflines费用cost*ICU病人镇静与镇痛yurongguoICU常用镇静药物的药理药物静脉起效时间半衰期副作用间断静脉剂量输注剂量范围安定Diazepam2-5min20-120hr静脉炎0.03-0.1Mg/kg咪唑安定midzolam2-5min3-11hr----0.02-0.08Mg/kg0.04-0.2Mg/kg/hr异丙酚propofol1-2min1.8-9.5min甘油三脂注射痛(1-2mg/kg)5-80ug/kg/min*ICU病人镇静与镇痛yurongguo顺行性遗忘作用强

——解除患者痛苦记忆，小剂量即可产生*ICU病人镇静与镇痛yurongguo易于与其他药物联合应用

——增加麻醉协同作用，效果更好，显著降低费用*ICU病人镇静与镇痛yurongguo耐