ICU镇痛躁动谵妄指南解读20131.pptVIP

;ICU镇痛镇静的临床意义;;2013,PAD guidelines;2013,PAD guidelines;What do the 2013,PAD Guidelines Say?;疼痛与镇痛Pain and Analgesia;ICU疼痛的发病率Incidence of Pain in ICU Patients; ICU疼痛评估Pain Assessment in ICU Patients;患者对疼痛的自我描述被认为是“金标准”，临床医生应该尝试首先让患者自己评价他们自己的疼痛。（B） A patient’s self-report of pain is considered the “gold standard,” and clinicians should always attempt to have a patient rate his or her own pain first（B). ;指南反对单纯根据生命体征（或包括生命体征在内的观察性疼痛量表）评估成年ICU患者的疼痛(-2C)。但指南同时建议生命体征可以作为患者需要接受进一步评估疼痛的线索(+2C)。 We do not suggest that vital signs (or observational pain scales that include vital signs) be used alone for pain assessment in adult ICU patients (–2C). We suggest that vital signs may be used as a cue to begin further assessment of pain in these patients, however (+2C). ; 如何对不能自述表达疼痛的患者进行疼痛的评估？;对于不能自行描述疼痛但运动功能正常，且表情行为可以被观察的ICU患者（不包括颅脑外伤），“行为疼痛评分表（BPS）”和“重症疼痛观察工具（CPOT）是监测这类ICU患者疼痛的最有效和可靠的疼痛量表。（B） The Behavioral Pain Scale (BPS) and the Critical- Care Pain Observation Tool (CPOT) are the most valid and reliable behavioral pain scales for monitoring pain （B） ;The Behavioral Pain Scale (BPS) the Critical- Care Pain Observation Tool (CPOT);The Behavioral Pain Scale (BPS);The Critical- Care Pain Observation Tool (CPOT);疼痛的治疗Treatment of Pain in ICU Patients;指南推荐静脉应用阿片类药物作为一线首选用药治疗非神经病理性疼痛（+1C）。 We recommend that IV opioids be considered as the first‐line drug class of choice to treat nonneuropathic pain in critically ill patients (+1C). 所有可应用的静脉阿片类药物，在滴定至相似的疼痛强度终点时，均具有同等效应（C）。 All available IV opioids, when titrated to similar painintensity endpoints, are equally effective (C).;指南建议应用非阿片类药物来减少阿片类药物的用量（或彻底解除静脉应用阿片类药物的需求），以减少阿片类药物相关的副作用（+2C）。 We suggest that non‐opioid analgesics be considered to decrease the amount of opioids administered (or to eliminate the need for intravenous opioids altogether), and to decrease opioid‐related side effects (+2C). 指南推荐对于神经病理性疼痛肠道内应用加巴喷丁，或卡马西平，来辅助静脉应用阿片类药物（+1A） We recommend that