镇痛镇静评估方法的局限与进步

The limitations and progress of analgesia and sedation assessments

由于自身疾病的特点以及多种不利因素的影响,ICU患者通常处于各种强烈的应激状态之中,为了有效地控制这些不良的应激反应,应用镇痛、镇静方法已成为治疗常规。然而研究证实,镇静过度或者镇静不足都会带来诸多不良的结果,如机械通气时间延长、呼吸机相关性肺炎(VAP)的发生风险增高以及谵妄发生率、ICU病死率增加等。因此,如何有效地管理好ICU患者的镇痛镇静,除镇痛镇静策略上的改进外,对镇痛镇静深度做到实时、准确的评估尤为重要。本文将对目前临床上常用的镇痛镇静评估方法各自的特点及优缺点做简要阐述。

ICU patients are in a various of intense stress state due to their diseases and other factors. Analgesic and sedative treatments are routine used to control these adverse stress responses effectively. However, studies have shown that both over and lack of sedation can lead to many adverse outcomes, such as prolonged mechanical ventilation, ventilator-associated pneumonia （VAP）, and increased delirium and mortality. Therefore, in addition to improved analgesic and sedative strategies, real-time and accurate assessment is important for analgesic and sedative management in ICU patients. Here, we review the characteristics of each analgesic and sedative assessments that widely used in clinic.