Pain is a common experience for inpatients,and intensive care unit(ICU)patients undergo more pain than other departmental patients,with an incidence of 50%at rest and up to 80%during common care procedures.At present,...Pain is a common experience for inpatients,and intensive care unit(ICU)patients undergo more pain than other departmental patients,with an incidence of 50%at rest and up to 80%during common care procedures.At present,the management of persistent pain in ICU patients has attracted considerable attention,and there are many related clinical studies and guidelines.However,the management of transient pain caused by certain ICU procedures has not received sufficient attention.We reviewed the different management strategies for procedural pain in the ICU and reached a conclusion.Pain management is a process of continuous quality improvement that requires multidisciplinary team cooperation,painrelated training of all relevant personnel,effective relief of all kinds of pain,and improvement of patients'quality of life.In clinical work,which involves complex and diverse patients,we should pay attention to the following points for procedural pain:(1)Consider not only the patient's persistent pain but also his or her procedural pain;(2)Conduct multimodal pain management;(3)Provide combined sedation on the basis of pain management;and(4)Perform individualized pain management.Until now,the pain management of procedural pain in the ICU has not attracted extensive attention.Therefore,we expect additional studies to solve the existing problems of procedural pain management in the ICU.展开更多
目的观察精准肝切除术患者在麻醉科ICU(anesthesia intensive care unit,AICU)应用右美托咪定对术后早期肝功能和谵妄的影响。方法选择精准肝叶切除术患者40例,男30例,女10例,年龄34～65岁,ASAⅡ或Ⅲ级,随机分为右美托咪定组(D组)和生...目的观察精准肝切除术患者在麻醉科ICU(anesthesia intensive care unit,AICU)应用右美托咪定对术后早期肝功能和谵妄的影响。方法选择精准肝叶切除术患者40例,男30例,女10例,年龄34～65岁,ASAⅡ或Ⅲ级,随机分为右美托咪定组(D组)和生理盐水组(S组),每组20例。入AICU后拔管前D组给予右美托咪定0.5μg·kg^(-1)·h^(-1)和丙泊酚0.5mg·kg^(-1)·h^(-1)持续静脉泵入,S组给予生理盐水和丙泊酚0.5mg·kg^(-1)·h^(-1);拔管后D组维持原剂量右美托咪定泵注,S组给予同等剂量生理盐水。两组患者均接受按压式镇痛泵术后镇痛。记录镇静有效率和按压次数;记录术前(T_0)、入AICU后即刻(T_1)和术后12h(T_2)血浆谷草转氨酶(AST)、谷丙转氨酶(ALT)和血乳酸(Lac)浓度;记录心动过缓、低血压、低血氧饱和度和术后谵妄等不良反应的发生情况。结果 D组镇静有效率明显高于S组[(80.2±13.0)%vs(61.8±14.7)%,P<0.05],镇痛泵按压次数明显少于S组[(2.3±0.7)次vs(4.1±1.2)次,P<0.05];与T_0时比较,T_1和T_2时两组AST、ALT和Lac浓度明显升高(P<0.05);与T_1时比较,T_2时两组AST、ALT和Lac浓度明显升高(P<0.05);T2时S组AST、ALT和Lac浓度明显高于D组(P<0.05)。两组心动过缓、低血压和术后谵妄[1(5%)vs 3(15%)]发生率差异无统计学意义。结论精准肝切除术患者在AICU期间使用右美托咪定可减少患者焦虑情绪,对肝脏功能有一定的保护作用。展开更多
文摘Pain is a common experience for inpatients,and intensive care unit(ICU)patients undergo more pain than other departmental patients,with an incidence of 50%at rest and up to 80%during common care procedures.At present,the management of persistent pain in ICU patients has attracted considerable attention,and there are many related clinical studies and guidelines.However,the management of transient pain caused by certain ICU procedures has not received sufficient attention.We reviewed the different management strategies for procedural pain in the ICU and reached a conclusion.Pain management is a process of continuous quality improvement that requires multidisciplinary team cooperation,painrelated training of all relevant personnel,effective relief of all kinds of pain,and improvement of patients'quality of life.In clinical work,which involves complex and diverse patients,we should pay attention to the following points for procedural pain:(1)Consider not only the patient's persistent pain but also his or her procedural pain;(2)Conduct multimodal pain management;(3)Provide combined sedation on the basis of pain management;and(4)Perform individualized pain management.Until now,the pain management of procedural pain in the ICU has not attracted extensive attention.Therefore,we expect additional studies to solve the existing problems of procedural pain management in the ICU.
