围手术期镇静和镇痛中值得注意的问题

Noteworthy issues involving the perioperative sedation and analgesia

术前焦虑的处理,大型手术后重症病人躁动、疼痛的合理评估和治疗,术后谵妄的合理镇静、镇痛,是围手术期值得关注的问题。术前焦虑不能仅凭镇静药物治疗,音乐、心理访谈等非药物手段可能更有益;对于大型手术后的重症病人,应先评估再治疗,先镇痛再镇静,并注意个体化选择镇痛、镇静药物;而术后谵妄极易被忽视并被错误治疗,值得引起注意。

Interventions of preoperative anxiety, assessment and treatment of agitation and pain in critical patients after major operation, sedation and analgesia for postoperative delirium are issues worthy of attention in perioperative period. Preoperative anxiety should not be treated merely by sedatives.Music listening and psychology interview may have more beneficial effect on it. As for critical patients, evaluation-first therapy and analgesia-first sedation should be applied as a strategy. Analgesics and sedatives should be selected based on individualization. It is worth noting that postoperative delirium is easy to be neglected and treated by wrong way.