休克病人的镇静镇痛治疗.ppt

Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,休克病人的镇静镇痛治疗,心源性休克紧急处理,坐,:,端坐位,氧：吸氧,吗：吗啡肌注,强：强心剂,休克病人的镇静镇痛治疗,2/52,降低休克患者焦虑应激,休克病人的镇静镇痛治疗,3/52,Epidemiology of anxiety for MV patients,Author,Cited from,Patient Type,Anxiety,Jones C,CCM,ICU,33/45 (73%),Rotondi,CCM,ICU,MV,100/150(67%),Swaiss,MEJA,ICU,MV,37/55 (68%),Sharon,AJCC,31 ICUs,73/106 (69%),Leur,Crt Care 04,ICU,MV,66/123 (54%),Hsiao,AATW,ICU,MV,Serious,休克病人的镇静镇痛治疗,4/52,sympathetic,Nerve,Medulla,Adrenaline,Non-adr,Heart,Vessels,Bronchi,Systematic stress responses,Beneficial,Harmful,休克病人的镇静镇痛治疗,5/52,休克时交感风暴,休克时大量内源性儿茶酚胺释放可诱发机体一系列行为、内分泌以及炎症介质急剧改变。,休克病人的镇静镇痛治疗,6/52,担心与恐惧发生在转运过程中,休克病人的镇静镇痛治疗,7/52,无机械通气病人更需要镇静,休克病人的镇静镇痛治疗,8/52,CPR,时邻床清醒患者心律失常发生情况,病例数,N=87,CPR时处理方法,对照组,26,用软布帘隔离,心理组,33,专职护士对其进行心理护理,镇静组,28,给予咪唑安定,0.1mg/kg,静脉注射。,李秦，马朋林 中国危重病抢救医学；,20(4):193-196,休克病人的镇静镇痛治疗,9/52,Heart rate changes in near bed conscious patients during CPR,休克病人的镇静镇痛治疗,10/52,SBP changes in near bed conscious patients during CPR,休克病人的镇静镇痛治疗,11/52,Plasma epinephrine alterations in near bed conscious patients during CPR,休克病人的镇静镇痛治疗,12/52,CPR,时邻床清醒患者心律失常发生情况,病例数,心律失常例数（百分率）,总例数 室上速 房性早搏 室性早搏 短阵室速,对照组,26,22,（,84.6,）,22,（,84.6,）,5,（,19.2,）,7,（,26.9,）,0,（,0,）,心理组,33,18,（,54.5,）,16,（,48.5,）,6,（,18.1,）,4,（,12.1,）,1,（,3.0,）,镇静组,28,6,（,21.4,）,6,（,21.4,）,0,（,0,）,2,（,7.1,）,0,（,0,）,P,值,0.05,0.01 0.01 0.05 72 hr,）,大剂量给药（,5mg/kg/hr,）,儿童（,65mmHg,SpO2:95%,SvO270%,Hb10 g/dl,皮肤无花斑等灌注不良表现,血乳酸异常增高（,5 mmol/l,）,pH7.2,休克病人的镇静镇痛治疗,45/52,尿液颜色显著改变,休克病人的镇静镇痛治疗,46/52,Guideline for sedation in patients with shock,No,yet.,中越战场：氯胺酮万岁！,休克病人的镇静镇痛治疗,47/52,Use of Ketamine Continuous Infusion for Pediatric Sedation in Septic Shock,severely compromised patient.,Ketamine,acts to increase heart rate,arterial pressure,and cardiac output.,Furthermore,antiendotoxin and an anti-tumor necrosis factor mechanism have been reported in animal models.,Pediatric Emergency Care 26,Number 9,休克病人的镇静镇痛治疗,48/52,休克病人的镇静镇痛治疗,49/52,氯胺酮作用不但仅是镇静,Anaesthesist,55:883891,休克病人的镇静镇痛治疗,50/52,总 结：,真主要！,恰当浅镇静，有效镇痛,监测镇静相关呼吸循环影响,推荐：休克早期复苏时选择,氯胺酮,+,咪唑安定,休克病人的镇静镇痛治疗,51/52,Thank you for your attention,休克病人的镇静镇痛治疗,52/52,