成人呼吸危重症患者镇痛镇静管理及相关问题专家共识  

Expert consensus on management of pain,agitation and related issues in adult patients with critical respiratory diseases

作　　者：中华医学会呼吸病学分会 中国医师协会呼吸医师分会危重症医学专家组 詹庆元 解立新[3] 程真顺[4] 陈淑靖[5] 侯俊娜 胡婷华[7] 李进华 李淑花 李绪言[10] 梁志科[11] 倪越男 孙丽娜[13] 闫百灵[14] 韦超洁 于歆 Chinese Thoracic Society,Chinese Medical Association;Critical Care Medicine Group,Chinese Association of Chest Physician,Chinese Medical Doctor Association;Yan Qingyuan;Xie Lixin;Cheng Zhenshun(不详;National Center for Respiratory Medicine,State Key Laboratory of Respiratory Health and Multimorbidity,National Clinical Research Center for Respiratory Diseases,Institute of Respiratory Medicine,Chinese Academy of Medical Sciences,Center of Respiratory Medicine,China-Japan Friendship Hospital,Beijing 100029,China;College of Pulmonary and Critical Care Medicine,Chinese PLA General Hospital,Beijing 100091,China;Department of Respiratory and Critical Care Medicine,Zhongnan Hospital of Wuhan University,Wuhan 430071,China)

机构地区：[1]不详 [2]国家呼吸医学中心呼吸和共病全国重点实验室、国家呼吸疾病临床研究中心、中国医学科学院呼吸病学研究院、中日友好医院呼吸中心,北京100029 [3]解放军总医院呼吸与危重症医学部,北京100091 [4]武汉大学中南医院呼吸与危重症医学科,武汉430071 [5]复旦大学附属中山医院 [6]郑州大学第一附属医院 [7]西安交通大学第一附属医院 [8]中南大学湘雅二医院 [9]山西医科大学第一医院 [10]首都医科大学北京朝阳医院 [11]广州市第一人民医院 [12]四川大学华西医院 [13]北京大学第三医院 [14]吉林大学白求恩第一医院 [15]武汉大学中南医院 [16]中日友好医院

出　　处：《中华结核和呼吸杂志》2023年第12期1162-1175,共14页Chinese Journal of Tuberculosis and Respiratory Diseases

基　　金：中央高水平医院临床科研业务费资助(2022-NHLHCRF-LX-01-01)。

摘　　要：呼吸危重症患者受自身疾病、制动、临床操作以及监护室环境等多种因素的影响,需要实施镇痛、镇静以降低患者不良应激并减少氧耗,且不同疾病对镇痛、镇静及早期活动等有不同的要求。为规范呼吸危重症患者镇痛、镇静、谵妄预防、早期活动及睡眠管理,中华医学会呼吸病学分会和中国医师协会呼吸病学分会危重症医学专家组共同发起并组织呼吸与危重症专家,基于循证医学证据及临床实践,撰写本共识,以指导临床实践。As patients with critical respiratory diseases suffer from the discomfort of disease,frequent medical and nursing procedures,and the noise disturbance of the ICU environment,it is necessary to implement analgesia and sedation to reduce their negative stress and oxygen consumption.Special emphasis will be placed on the clinical practice of analgesia,sedation and rehabilitation in critically ill patients with respiratory diseases,as different pathophysiological features of the respective pulmonary diseases are presented,such as severe asthma and acute exacerbations of chronic obstructive pulmonary disease,as well as the exclusive situations during respiratory therapy,such as recruitment maneuvers,bedside bronchoscopy and operation of extracorporeal membrane oxygenators.To standardize the prevention and management of pain,agitation,delirium,immobility,and sleep disturbance in adult patients with critical respiratory diseases,the Chinese Thoracic Society and Critical Care Medicine Group of Chinese Association of Chest Physicians,Chinese Medical Doctor Association organized pulmonary and critical care experts to discuss 19 important issues and ultimately provided 20 recommendations based on the best available evidence.Assessment,prevention and management of pain should be prioritized before the administration of continuous infused sedatives in all patients with critical respiratory diseases.Bundles that include multiple strategies of non-pharmacological interventions to prevent and manage delirium and sleep disruption are encouraged.For the patients with stable respiratory and hemodynamic status,early mobility and exercise could be safe and beneficial.Respiratory drive control by addressing patient and ventilator factors should be the priority before administration of analog-sedation protocol in the ARDS patients.Deep sedation could be necessary in the early stage of ARDS with high respiratory drive,and during the recruitment maneuver,prone position and measurement of the respiratory mechanics.Maintaining spontaneous

关 键 词：中国医师协会 中华医学会 自身疾病 循证医学证据 危重症医学 临床操作 临床实践 谵妄 

分 类 号：R459.7[医药卫生—急诊医学]