Sessler C N, Grap M J, Brophy G M
Division of Pulmonary and Critical Care Medicine, Medical College of Virginia Hospital, Virginia Commonwealth University, Richmond, Virginia 23298-0050, USA.
Semin Respir Crit Care Med. 2001;22(2):211-26. doi: 10.1055/s-2001-13834.
Management of sedation and analgesia in critical care medicine is a multidisciplinary process that involves physicians, nurses, pharmacists, and other healthcare providers. Optimal management of these common issues includes recognition of the importance of predisposing and causative conditions that contribute to the sensations of pain and discomfort, anxiety, and delirium. Treatment includes pharmacological intervention, correction of predisposing factors, and use of other preventative and nonpharmacological measures. It is increasingly clear that, although necessary for patient comfort, sedative and analgesic medications can have adverse consequences, including side-effects as well as prolonged mechanical ventilation and ICU length of stay. Optimal use of sedative and analgesic medications involves matching unique properties of specific medications with individual patient characteristics. Guidelines that minimize unnecessary variability in practice, prevent excessive medication, and emphasize management based on individual patient characteristics improve the effective utilization of these medications.
重症医学中镇静和镇痛的管理是一个多学科过程，涉及医生、护士、药剂师和其他医疗服务提供者。对这些常见问题的最佳管理包括认识到导致疼痛、不适、焦虑和谵妄等感觉的诱发因素和致病条件的重要性。治疗包括药物干预、纠正诱发因素以及使用其他预防和非药物措施。越来越明显的是，尽管镇静和镇痛药物对患者舒适度是必要的，但它们可能会产生不良后果，包括副作用以及机械通气时间延长和重症监护病房住院时间延长。镇静和镇痛药物的最佳使用涉及将特定药物的独特特性与个体患者特征相匹配。尽量减少实践中不必要的变异性、防止过度用药并强调基于个体患者特征进行管理的指南，可提高这些药物的有效利用率。
