加護病房持續性鎮靜止痛治療

The Continuous Sedative Therapy in the Intensive Care Unit

加護病房的病人常必須承受疾病本身及治療所引起的疼痛與焦慮等壓力。尤其大多數的病人需由氣管內插管或氣切造口依賴人工呼吸機，為了讓病人獲得舒適及安全的機械通氣治療，減少壓力反應所造成不利健康因素及人道考量上，鎮靜與止痛治療已經被認為是加護病房醫療照護相當重要的品質指標之一。而根據2002年美國重症醫學院與重症醫學會建議加護病房適用之止痛鎮靜藥物有Fentanyl、morphine、midazolam、propofol、lorazepam，對於控制譫妄的用藥為haloperidol。本文簡述使用鎮靜治療之時機、治療成效的評估方法、藥物之臨床運用及護理注意事項提供護理人員參考。

Beside physical illness, ICU patients suffer from great stress due to invasive monitoring procedure, pain, and anxiety, especially those who are intubated.Therefore, sedation and analgesics are broadly applied in ICU patients to minimize the stress reaction, to make patient more comfortable and to improve the quality of critical care. According to the guideline of the American College Critical Medicine of the Society of Critical Care Medicine in 2002, suggest the use of morphine or fentanyl for pain relief, haloperidol for the management of delirium, lorazepam for the mangement or anxiety, and low-dose lorazepam for sleep deprivatin. Propofol is suggsted for unrelieved anxiety when extubation is expected to occur within 24hrs.This is a brief review about the indication of sedation, application of medication, and clinically nursing guidelines.