优化镇痛镇静 加速重症患者康复

Effects of optimum analgesia and sedation on enhanced rehabilitation in critically ill patients

镇痛镇静是重症治疗重要的组成部分,旨在消除或减轻患者的疼痛、焦虑以及躁动,同时有助于抑制机体应激反应,降低器官氧耗氧需,发挥器官保护作用。镇痛镇静的实施原则是镇痛优先,最小化镇静及以患者为中心的人文关怀,确保重症治疗顺利进行,降低应激反应及医疗相关的继发损害。文中阐述以加速重症患者康复为导向,提倡实施目标导向性镇痛镇静策略,避免长期和深度镇痛镇静带来的再损伤;实施多模态镇痛方案,减少阿片类药物的使用及其相关的不良反应;关注重症患者谵妄的预防和管理,有助于早期启动康复运动并改善短-长期认知功能。

Effective analgesia and sedation is important for critically ill patients..It aims to eliminate or relieve pain,anxiety and agitation during intensive care and at the same time help to reduce the host stress response and inflammation,decrease oxygen exhaustion and demand,and protect organ function and enhances recovery.The principle of analgesia and sedation is to give priority to analgesia,minimize sedation,and patient-centered humanistic care to ensure the smooth progress of intensive treatment,and reduce stress response and medically related secondary damage.To achieve enhanced rehabilitation in critically ill patients,we proposed three aspects for optimum analgesia and sedation.Firstly,target-based analgesia and sedation protocol is imperative for achieving effective analgesia and sedation,and also it is important to avoid adverse effects caused by over use of drugs.Secondly,multi-modal analgesia is preferable to maximize the analgesia while being able to limit the dose and thereby side effects of opioids,such as inhibition of respiratory system and bowl movement.At last,prevention and management of acquired delirium is helpful for early initiation of physical exercise and improvement of short-and long-term cognition function.