Behne M
Zentrum der Anaesthesiologie und Widerbelebung, Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt am Main.
Anaesthesist. 1995 Dec;44 Suppl 3:S535-9.
This lecture outlines the current pharmacological concepts of sedation and analgesia in the critically ill patient requiring intensive care therapy. The primary goal is to sedate such patients so that they tolerate mechanical ventilation, as well as the therapeutic and diagnostic procedures that are routinely performed on an intensive care ward. The pharmacological regimen comprises both anxiolytic and analgesic drugs. So far, no drug combination has been identified as the ideal therapy; the standard deviation of successful analgosedation is large due to an unpredictable individual response. Because the drugs currently used are free of toxic side effects, the selection made is mainly determined by factors relating to pharmacokinetic criteria, such as short half-life of action or a predictable time of elimination. So far, the selection or combination of certain drugs has not been found to influence the patient's outcome in severe disease states such as sepsis, multiple trauma, or neurotrauma. "Good quality" of sedation and analgesia is still judged by its ability to suppress tachycardia, hypertension, hyperventilation or respiratory efforts against mechanical ventilation and the absence of increases in intracranial pressure during therapeutic manoeuvres.
本讲座概述了在需要重症监护治疗的危重病患者中，当前关于镇静和镇痛的药理学概念。主要目标是使此类患者镇静，以便他们耐受机械通气以及重症监护病房常规进行的治疗和诊断程序。药理学方案包括抗焦虑药和镇痛药。到目前为止，尚未确定哪种药物组合是理想的治疗方法；由于个体反应不可预测，成功进行镇痛镇静的标准差很大。由于目前使用的药物没有毒性副作用，因此选择主要由与药代动力学标准相关的因素决定，例如作用半衰期短或消除时间可预测。到目前为止，尚未发现某些药物的选择或组合会影响脓毒症、多发伤或神经创伤等严重疾病状态下患者的预后。镇静和镇痛的“质量良好”仍通过其抑制心动过速、高血压、过度通气或对抗机械通气的呼吸努力的能力以及在治疗操作期间颅内压不升高来判断。
