Drew Debra J, St Marie Barbara J
University of Minnesota Medical Center, Fairview, Minneapolis, MN 55455, USA.
AACN Adv Crit Care. 2011 Jul-Sep;22(3):238-54; quiz 255-6. doi: 10.1097/NCI.0b013e318220c504.
Opioid tolerance resulting from long-term opioid consumption for chronic pain or from substance use disorder adds a layer of complexity to managing pain in the critical care setting. This article discusses similarities and differences of these 2 conditions. The phenomenon of tolerance and opioid-induced hyperalgesia are presented. Prevention of opioid withdrawal, when patients are on methadone or buprenorphine, is described. An overview of the neurophysiology of pain and substance use disorder is presented. Practical clinical suggestions are given to assist the critical care nurse in caring for these complex patients.
长期使用阿片类药物治疗慢性疼痛或因物质使用障碍导致的阿片类药物耐受性，给重症监护环境下的疼痛管理增加了一层复杂性。本文讨论了这两种情况的异同。介绍了耐受性现象和阿片类药物诱导的痛觉过敏。描述了患者服用美沙酮或丁丙诺啡时预防阿片类药物戒断的方法。概述了疼痛和物质使用障碍的神经生理学。给出了实用的临床建议，以帮助重症监护护士护理这些复杂的患者。
