icu镇痛镇静ppt课件.ppt

ICU镇痛镇静:---根据器官功能?选用哪些指标进行器官功能评估?如何实施精准镇静?-1999萌芽状态,?;13(6):,各研究中的“最佳镇静”的定义差异很大,同时评估方法差异也很大。—fortandrecallofsource-specific,fortableexperiencesMaPenglin,(2010)25,451–457一项前瞻性,观察性队列研究31个ICU中心(n=163)-75%之间,大多数报道>20%。%-44%,镇静不足2-31%;13(6):,etal.,2006[30]RamsayscaleIndividualtoeachpatientHarper,etal.,1991[25]Ramsay(assessedhourly)2-5Carson,etal.,2006[22]Ramsay2-3Anis,etal.,2002[31],Hall,etal.,2001[60]RamsayIndividualtoeachpatientMacLaren,etal.,2007[42]Ramsayscore4-5Shehabi,etal.,2004[2Ramsay2-4Tallgren,etal.,2006[3]Ramsay/Carrasco,etal.,1993[26]Ramsayscale;ascale(modifiedbyCookandPalma)Ramsayscale2-5,ascale8-ollam,etal.,1999[23]Ramsayscale;ascale(modifiedbyCookandPalma)Ramsayscale2-5,ascale8-,etal.,2000[36]ModifiedRamsayEquivalentofRamsay5-6(fordeepsedation)Barr,etal.,2001[34]ModifiedRamsay3-4(5-6=oversedation)Finfer,etal.,1999[33]ModifiedRamsay1-4Richman,etal.,2006[37]ModifiedRamsayIndividualtoeachpatientMacLaren,etal.,2000[35]ModifiedRamsay4Payen,etal.,2007[43]Multiple:monlyRamsay,RASS,Sedation-AgitationscaleOver-sedationdefinedasRamsay5-6,RASS-5or–4,Sedation-Agitationscale1-2Chinachoti,etal.,2002[40]SASSAS4withnoormildpain2-3(plussubjectivenurseassessment)SAS4Karabinis,etal.,2004[39]SAS1-3MacLaren,etal.,2007[42]SAS3-?何时该深,:前瞻性、多中心(6个)、随机对照、非盲平行研究。患者分组:早期目标导向镇静(EGDS)组、标准镇静方案(STDS)组镇静目标:两组均为浅镇静(RASS-2~-1)结论:实施早期目标导向镇静是安全可行的,有利于达到早期轻度镇静,减少苯二氮卓类药物和丙泊酚的使用,减少物理约束的需求。10.