Astle Sonia M
Department of Critical Care, Inova Fairfax Hospital, 3300 Gallows Road, Falls Church, VA 22042, USA.
Crit Care Nurs Clin North Am. 2009 Sep;21(3):323-39, v-vi. doi: 10.1016/j.ccell.2009.07.012.
Achieving pain control in critically ill patients is a challenging problem for the health care team, which becomes more challenging in morbidly obese patients. Obese patients may experience drug malabsorption and distribution, which may lead to either subtherapeutic or toxic drug levels. To manage pain effectively for the critically ill obese patient, nurses must have an understanding of how obesity alters a patient's physiologic response to injury and illness. In addition, nurses must be knowledgeable about physiologic pain mechanisms, types and manifestations of pain, differing patterns of drug absorption and distribution, pharmacokinetic properties of analgesic medications, and pain management strategies. This article explores factors affecting pharmacokinetics in obese patients, trends in pain management, and treatment strategies for the obese patient.
对医疗团队而言，在重症患者中实现疼痛控制是一个具有挑战性的问题，而在病态肥胖患者中这一问题更具挑战性。肥胖患者可能会出现药物吸收和分布异常，这可能导致药物水平低于治疗剂量或出现毒性。为了有效管理重症肥胖患者的疼痛，护士必须了解肥胖如何改变患者对损伤和疾病的生理反应。此外，护士必须熟知生理疼痛机制、疼痛的类型和表现、药物吸收和分布的不同模式、镇痛药物的药代动力学特性以及疼痛管理策略。本文探讨了影响肥胖患者药代动力学的因素、疼痛管理的趋势以及肥胖患者的治疗策略。
