Page Valerie J, McAuley Daniel F
aIntensive Care Unit, Watford General Hospital, Watford bFaculty of Medicine, Imperial College, London cCentre for Infection and Immunity, Queen's University of Belfast dRegional Intensive Care Unit, Royal Victoria Hospital, Belfast UK.
Curr Opin Anaesthesiol. 2015 Apr;28(2):139-44. doi: 10.1097/ACO.0000000000000174.
There is recognition that the use of sedative drugs in critically ill patients is potentially harmful, particularly in relation to ICU delirium and clinical outcomes. In that context, there is an increasing interest in maintaining light sedation, the use of non-gamma-aminobutyric acid agonist agents and antipsychotics.
The sedative drugs currently available have limitations relating to duration of action, cost or variability in response. Recent reviews and meta-analyses comparing sedatives in ICU patients differ in their findings depending on whether trials in elective cardiac surgical patients are included. Dexmedetomidine does appear to reduce the number of ventilator days in the less sick critically ill patient. There is currently no evidence to support the routine use of antipsychotics in ICU patients to prevent or treat delirium, although they will reduce agitation and they appear to be well tolerated when used in the critically ill patient. Sedation protocols and early mobilization reduce the use of sedative drugs and improve some outcomes but are challenging to implement in practice.
The bedside clinician needs to balance the need to sedate the patient and maintain life-saving support, while keeping their patient responsive, cooperative and pain free.
人们认识到在危重症患者中使用镇静药物可能有害，尤其是在与重症监护病房（ICU）谵妄及临床结局相关方面。在此背景下，维持浅镇静、使用非γ-氨基丁酸激动剂药物及抗精神病药物的关注度日益增加。
目前可用的镇静药物在作用持续时间、成本或反应变异性方面存在局限性。近期比较ICU患者镇静药物的综述和荟萃分析，其结果因是否纳入择期心脏手术患者的试验而有所不同。右美托咪定似乎能减少病情较轻的危重症患者的机械通气天数。目前没有证据支持在ICU患者中常规使用抗精神病药物来预防或治疗谵妄，尽管它们能减少躁动，且在危重症患者中使用时耐受性似乎良好。镇静方案和早期活动可减少镇静药物的使用并改善一些结局，但在实际操作中实施具有挑战性。
床边临床医生需要在使患者镇静并维持救命支持的需求与让患者保持反应性、合作性且无疼痛之间取得平衡。
