Imperatore Francesco, Marsilia Paolo Francesco, Munciello Francesco, Liguori Giovanni, Borrelli Luigi Maria, Gatta Gianluca, Martino Antonio, Occhiochiuso Luigi
Unit of Anesthesia and Intensive Care, Department of Emergency, A. Cardarelli Hospital, Naples, Italy.
MedGenMed. 2003 Nov 12;5(4):22.
Propofol has been shown to produce a predictable and easily attainable level of sedation in postcardiac, head-injured, general trauma patients. The commencement of hemodiafiltration itself has not been shown to significantly influence the requirement for propofol. We report on a patient who underwent binephrectomy complicated by sepsis-induced adult respiratory distress syndrome (ARDS).
Case report.
Largest nonteaching hospital in Southern Italy.
PATIENTS/SUBJECTS: An 18-year-old male underwent a surgical procedure for splenectomy and right nephrectomy for severe abdominal trauma. On the 10th postoperative day, the patient was admitted into our intensive care unit (ICU) for acute respiratory and renal failure due to ARDS and left renal infarction.
Continuous venovenous hemodiafiltration was carried out through a double-lumen cannula. Sedation was initially achieved with propofol up to standard doses into a nonfemoral venous site. Because the optimal level of sedation was not achieved, the initial propofol infusion rate was increase to 3.5 mg/kg, and then an intravenous bolus of morphine (.01 mg/kg) was administered twice daily.
The administration of morphine was fundamental to achieving an optimal level of sedation. ARDS resolved and, 10 days later, the patient was transferred to the surgical unit, then discharged home after 14 days.
Hemodiafiltration was found to influence the clinical requirement for propofol. The optimal level of sedation is achieved with the addition of morphine.
已证明丙泊酚能在心脏术后、颅脑损伤、全身创伤患者中产生可预测且易于达到的镇静水平。血液透析滤过的开始本身并未显示会显著影响丙泊酚的用量。我们报告一例接受双侧肾切除术并并发脓毒症诱发的成人呼吸窘迫综合征（ARDS）的患者。
病例报告。
意大利南部最大的非教学医院。
患者/受试者：一名18岁男性因严重腹部创伤接受了脾切除术和右肾切除术。术后第10天，患者因ARDS和左肾梗死导致的急性呼吸和肾衰竭入住我们的重症监护病房（ICU）。
通过双腔导管进行持续静脉-静脉血液透析滤过。最初在非股静脉部位使用丙泊酚达到标准剂量来实现镇静。由于未达到最佳镇静水平，最初的丙泊酚输注速率增至3.5毫克/千克，然后每天两次静脉推注吗啡（0.01毫克/千克）。
吗啡的使用对于达到最佳镇静水平至关重要。ARDS得到缓解，10天后患者转至外科病房，14天后出院回家。
发现血液透析滤过会影响丙泊酚的临床用量。添加吗啡可达到最佳镇静水平。
