Tran H T, Ackerman B H, Wardius P A, Haith L R, Patton M L
Department of Pharmacy Practice, Northeast Louisiana University 71209, USA.
Pharmacotherapy. 1996 Jan-Feb;16(1):75-8.
A patient with a long-standing history of chronic obstructive pulmonary disease suffered a thermal injury over 20% of his total body surface area. He required opiates for pain management and benzodiazepines for anxiety associated with dressing changes. The narcotics compromised his pulmonary function and level of consciousness, and interfered with several attempts to wean him from ventilator support. Intravenous ketorolac instead of narcotics before dressing changes alleviated the respiratory depression and returned his partial pressure of carbon dioxide-mediated respiratory drive to normal. With these changes, including changes in respiratory rate to tidal volume, he was successfully weaned from ventilatory support. In addition, the patient's level of consciousness improved. These changes increased his participation in his daily physical therapy sessions.
一名有长期慢性阻塞性肺疾病病史的患者，全身20%以上体表面积遭受热损伤。他需要使用阿片类药物进行疼痛管理，并使用苯二氮䓬类药物来缓解与换药相关的焦虑。麻醉药物损害了他的肺功能和意识水平，并干扰了几次让他脱离呼吸机支持的尝试。换药前静脉注射酮咯酸而非麻醉药物，减轻了呼吸抑制，使他由二氧化碳分压介导的呼吸驱动恢复正常。通过这些改变，包括呼吸频率与潮气量的变化，他成功脱离了呼吸机支持。此外，患者的意识水平有所改善。这些变化增加了他参与日常物理治疗的程度。
