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儿科重症监护病房 (PICU) 中的患儿往往存在疼痛、焦虑和恐惧等情况,尤其在有创操作和机械通气等情况下,通常需要使用药物来镇静和镇痛。常用镇静或镇痛的药物有苯二氮类药物、全身麻醉剂、阿片类药物、非甾体抗炎药 (NSAID)、局部麻醉剂等,其中苯二氮类药物为首选镇静药,目前国内仍以地西泮为主,而国外则以更适合于儿科患者的咪达唑仑为主。阿片类药物是PICU的一线镇痛药物。对于心血管系统稳定的患儿来说,使用吗啡既有效又经济;芬太尼则因镇痛效果强、不良反应少,在新生儿的应用中显示出更大的优越性,目前有迅速取代吗啡的趋势。NSAID常用于炎性疼痛,与阿片类药物具有协同作用。在会引起较剧烈疼痛的有创操作前,肌肉注射氯胺酮不失为一种有效方法。另外,局部麻醉技术有时能产生高质量的镇痛效果。本文重点介绍PICU中近年常用的及新开发的镇静药和镇痛药。
Children in pediatric intensive care units (PICU) often experience pain, anxiety and fear, and often require medication to calm and ease pain, especially during invasive procedures and mechanical ventilation. Commonly used sedative or analgesic drugs benzodiazepine drugs, general anesthetics, opioids, non-steroidal anti-inflammatory drugs (NSAIDs), local anesthetics, etc., of which benzodiazepines are the preferred sedatives, the current still Diazepam-based, while abroad is more suitable for pediatric patients with midazolam-based. Opioids are PICU’s first-line pain killers. For children with stable cardiovascular system, the use of morphine is both effective and economical; fentanyl shows greater superiority in neonatal application due to its strong analgesic effect and few adverse reactions, and there is a rapid replacement Morphine trend. NSAIDs are commonly used for inflammatory pain and have synergistic effects with opiates. Intramuscular injection of ketamine is an effective method of invasive surgery before it can cause more severe pain. In addition, local anesthetic techniques can sometimes produce high quality analgesic effects. This article highlights the commonly used and newly developed sedatives and analgesics in PICUs.