机械通气患者的疼痛评估与镇痛策略演变  

Progress of pain assessment and analgesia strategy for mechanical ventilation patients

作　　者：李青栋[1] 万献尧[1] Li Qingdong Wan Xianyao(Department of Critical Care Medicine, the First Affiliated Hospital of Dalian Medical University, Critical Care Medical Research Institute of Dalian Medical University, Dalian 116011, Liaoning, China)

机构地区：[1]大连医科大学附属第一医院重症医学科,大连医科大学重症医学研究所,辽宁大连116011

出　　处：《中华危重病急救医学》2017年第9期861-864,共4页Chinese Critical Care Medicine

基　　金：辽宁省教育厅科学研究一般项目（L2014342）;中华医学会临床医学科研专项基金项目（13091460513）

摘　　要：机械通气患者的规范化疼痛评估是合理镇痛的前提,但重症加强治疗病房（ICU）患者常规进行疼痛评估的比例很低.机械通气患者如不能自我表达疼痛,可采用疼痛行为量表（BPS）和重症监护疼痛观察工具（CPOT）进行疼痛评估.无论采取何种策略,必须镇痛优先,同时应结合患者的具体情况采取以患者为中心的个体化目标导向性镇静.在病情容许的前提下,尽可能维持患者处于＂浅镇静＂状态可能改善预后.对患者实施人文关怀、多学科协作以及全面临床医师培训也是理想镇痛策略的重要环节.Standardized pain assessment is a precondition of appropriate analgesia for mechanical ventilation patients. However, routine pain assessment rates remain very low in intensive care unit （ICU）. Behavioral pain scale （BPS） and critical-care pain observation tool （CPOT） can be used to assess pain in mechanical ventilation patients who are unable to report pain by themselves. No matter what strategy we taken, analgesia-first sedation should be used in priority. Meanwhile, patient-centered and goal-directed sedation strategy should be adopted based on the individual condition.If condition permits, patients should be maintained in light states of sedation as long as possible, because this is associated with improved clinical outcomes. Humanistic care, multidisciplinary cooperation and comprehensive training are also important components of a perfect analgesia strategy.

关 键 词：重症加强治疗病房 疼痛 机械通气 镇痛 

分 类 号：R459.7[医药卫生—急诊医学]