镇痛镇静的终极目的:为何且如何实现器官保护?

Ultimate goal of analgesia and sedation-why and how we protect organs

镇痛镇静在重症患者救治中的地位逐渐上升,从以往仅以改善患者舒适度为目的,进入镇静兼有器官保护作用的新时代。镇痛镇静在改善呼吸窘迫、人机同步性、降低跨肺压,降低氧耗量、改善组织缺氧、控制颅内压和脑代谢、调节免疫和炎症反应等方面,均有关键性的作用,有可能成为器官功能保护和免疫炎症调理的重要治疗措施之一。根据器官障碍严重程度实施分层镇痛镇静,并实施目标导向的镇痛镇静策略,可为镇痛镇静实现器官保护提供可靠的保障。

Analgesia and sedation are essential for critically ill patients. Now we change our target from patients′ comfort to organ protection. Analgesia and sedation have an important role in reducing respiratory distress, improving synchrony of mechanical ventilation, lowering transpulmonary pressure, reducing oxygen consumption, controlling intracranial pressure and metabolism, optimization of immune and inflammation. An organ protection directed sedation strategy will be more optimal in the future.