Barr J
Stanford University School of Medicine, California, USA.
Int Anesthesiol Clin. 1995 Winter;33(1):131-54.
Patients in the ICU who require intubation and mechanical ventilation benefit from adequate sedation and analgesia. Traditionally, this has been achieved using benzodiazepines and opioids. Alternatively, propofol is being administered for sedation of patients in the ICU with increasing frequency. Propofol has a number of properties that make it a potentially superior choice for sedation of intubated ICU patients. The rapid onset and offset of sedation with propofol, even after prolonged administration, allow for greater control over the level of sedation and more rapid weaning from mechanical ventilation. In addition, long-term administration of propofol does not appear to be associated with the development of tolerance, addiction, or withdrawal following discontinuation. Propofol suppresses cellular oxygen consumption and carbon dioxide production without increasing anaerobic metabolism. This may be beneficial in patients with severe hypoxemia, hypercarbia, or myocardial ischemia. Finally, the use of propofol may reduce or eliminate the need for other medications in these patients such as muscle relaxants, antihypertensives, lipid nutritional supplements, and analgesics, thereby simplifying their medication regimens and reducing the overall cost of their care while in the ICU. Propofol can be administered to critically ill patients for sedation with a high degree of safety and efficacy. Propofol causes systemic vasodilatation which may result in unwanted hypotension, especially in patients who are already hemodynamically compromised. Propofol also causes ventilatory depression, so its use should be restricted in the ICU to patients whose airway is protected by an endotracheal tube and whose ventilation is closely monitored. Finally, continuous administration of propofol may cause clinically significant hypertriglyceridemia in patients with disordered triglyceride metabolism, or in patients receiving excessive doses of propofol or parenteral lipid supplements. Although propofol is more expensive than equipotent doses of other sedative agents, the additional cost of using propofol for sedation of critically ill patients in the ICU may be more than offset by the savings accrued from faster times to extubation, shorter ICU stays, and the use of fewer medications to manage these patients. Further research needs to be done to determine the potential clinical and cost benefits of using propofol for sedation of patients in the ICU.
重症监护病房（ICU）中需要插管和机械通气的患者可从充分的镇静和镇痛中获益。传统上，这是通过使用苯二氮䓬类药物和阿片类药物来实现的。另外，丙泊酚在ICU患者镇静中的使用频率正在增加。丙泊酚具有许多特性，使其成为插管ICU患者镇静的潜在更佳选择。丙泊酚镇静起效快、停药后苏醒也快，即使长期给药亦是如此，这使得对镇静水平的控制更强，机械通气撤机更快。此外，长期使用丙泊酚似乎与停药后耐受性、成瘾性或戒断反应的发生无关。丙泊酚可抑制细胞耗氧量和二氧化碳生成，而不增加无氧代谢。这对患有严重低氧血症、高碳酸血症或心肌缺血的患者可能有益。最后，使用丙泊酚可能会减少或消除这些患者对其他药物（如肌肉松弛剂、抗高血压药、脂质营养补充剂和镇痛药）的需求，从而简化他们的用药方案，降低在ICU期间的总体护理成本。丙泊酚可用于危重症患者的镇静，具有高度的安全性和有效性。丙泊酚可引起全身血管扩张，这可能导致不良的低血压，尤其是在已经存在血流动力学不稳定的患者中。丙泊酚还可引起通气抑制，因此在ICU中其使用应限于气道由气管内导管保护且通气受到密切监测的患者。最后，持续输注丙泊酚可能会在甘油三酯代谢紊乱的患者中，或在接受过量丙泊酚或肠外脂质补充剂的患者中引起具有临床意义的高甘油三酯血症。虽然丙泊酚比等效剂量的其他镇静剂更昂贵，但在ICU中使用丙泊酚为危重症患者镇静所增加的成本，可能会被拔管时间更快、ICU住院时间更短以及管理这些患者所需药物减少所带来的节省所抵消。需要进一步研究以确定在ICU中使用丙泊酚为患者镇静的潜在临床和成本效益。
