icu鎮(zhèn)靜鎮(zhèn)痛ppt課件(編輯修改稿)
2025-02-15 01:54 本頁(yè)面
【文章內(nèi)容簡(jiǎn)介】 ? Site selectio ICU:Medical ICU Threebed room ? BRCU:Threebed RCU room SRCU:Single RCU room PR:Private room on a genral medical floor ? Light monitoring ? Sound monitoring ? Patient Interrruptions Vital sign,medication dosing,nursing care, respiratory care,diagnostic studies,medical exams,time with visitors Adverse Enviromental Condition in ICU Average number of sound values80 dB for each 6h period Light levels (lux) and sound levels (dB) Averaged over 7d ? ICU患者需要鎮(zhèn)靜鎮(zhèn)痛嗎？ ? 應(yīng)用鎮(zhèn)痛鎮(zhèn)靜藥的目的 內(nèi) 容 提 要 ? Stress response ? Change endocrine function ? Hypermetabolism ? Sodium and water retention ? Increase lipolysis ? Sympathetic overactivity:HR RR Mvo2 ? Increase global and respiVo2 鎮(zhèn) 靜 不 足 ? Increase risk of DVT and PE ? Decrease in testinal motility ? Hypotension ? Reduce tissue oxygen extraction ? Prolong ICU stay ? Increase cost Excessive sedation ? Keep patient fortable ? But easily aroused 鎮(zhèn) 靜 目 標(biāo) 對(duì)于需要快速蘇醒的患者， 丙泊酚 為美國(guó)指南推薦的 ICU鎮(zhèn)靜首選藥物 美國(guó) 《 危重病成人患者持續(xù)使用鎮(zhèn)靜劑和止痛劑的臨床實(shí)踐指南 》 ? 需要快速蘇醒時(shí)（例如，進(jìn)行神經(jīng)學(xué)評(píng)價(jià)或拔管），首選 丙泊酚 鎮(zhèn)靜 ? 咪唑安定僅建議短期使用，因?yàn)槌掷m(xù)輸入 4872小時(shí)以上時(shí)，它的蘇醒時(shí)間和拔管時(shí)間無(wú)法預(yù)測(cè) . 中國(guó)指南推薦的 ICU鎮(zhèn)靜藥物 中國(guó) 《 ICU病人鎮(zhèn)痛鎮(zhèn)靜治療指南 》 ?對(duì)急性躁動(dòng)病人可以使用 咪唑安定、安定或丙泊酚 來(lái)獲得快速的鎮(zhèn)靜 ?需要快速蘇醒的鎮(zhèn)靜，可選擇 丙泊酚 ?短期的鎮(zhèn)靜可選用 咪唑安定或丙泊酚 ICU病人鎮(zhèn)痛鎮(zhèn)靜治療指南（初稿） .中華醫(yī)學(xué)會(huì)重癥醫(yī)學(xué) 2022年全國(guó)學(xué)術(shù)研討會(huì) , 5月 11～ 15日 ,江蘇南京 . All excuses are too weak to release the burthen on our heart Care giver’s contribution Unexpected Extubation ?Am J Respir Crft Care Med 1994。157:1131 48615812010203040506070合作 躁動(dòng) 約束帶 鎮(zhèn)靜劑Previous Literatures Review (2022 ~ 2022) Percentage of patients with anxiety in their ICU stay 54 % ~ 73 % Conducted by Chinese Society of CCM Nationwide Survey (32 ICUs) Data collected from June 15July 15, 234 ICU survivor were interviewed Current data in Chinese ICU Most of them felt disfort 45% 10% 15% 30% Serious disfort Comfort amp。 Amnesia Middle disfort Slight disfort EmotionFear No Fear 33% 17% 24% 26% Slightly Serious Meddle Emotion Anxiety % % % % No Anxiety Slightly Seriou
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