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頁籤選單縮合
題名 | 鎮靜劑及神經肌肉阻斷劑在神經外科加護重症之應用=Sedatives and Neuromuscular Blockade in Neurosurgical Intensive Care |
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作 者 | 黃勝堅; 黃約翰; 高明見; | 書刊名 | 中華民國重症醫學雜誌 |
卷期 | 3:1 2001.01[民90.01] |
頁次 | 頁90-102 |
分類號 | 418.2131 |
關鍵詞 | 鎮靜劑; 神經肌肉阻斷劑; 神經重症加護; 顱內壓; 指導原則; Sedatives; Neuromuscular blockade; Neurosurgical intensive care; Intracranial pressure; Guidelines; |
語文 | 中文(Chinese) |
中文摘要 | 在現代的神經加護重症照護中,鎮靜劑及神經肌肉阻斷劑的角色愈來愈重要。一方面考慮人性化的照顧,另一方面考慮腦部功能的救護。雖然有些學者以某些理由反對,例如:影響意識之評評與神經學的檢查、住加護病房的時間延夷、感染率增加及併發症等,但是贊成使用者卻認為這些缺點是可以克服的,而且最大的優點是:一、使用呼吸器方便;二、顱內壓容易控制。除此之外,對腦部更可以達到降低代謝率,避免腦部缺血的效果。目前常用的鎮靜藥物有Propofol、Midazolam及Lorazepam。回顧文獻,三者的鎮靜效果不相上下。Midazolam及Lozazepam在癲癇重積症的治療有明顯的效果。常用的神經肌肉阻斷劑有Pancuronium、Vecuronium及Atracurium。後二者為中短效型,目前神經加護病房使用較多,但是所需的花費也較高。如何避免的神經肌肉阻斷劑及鎮靜劑的副作用及併發症,以及如何選擇適當的藥物給不同的神經重症病人使用,建立一套完整而有牙的藥物使用指導原則以及監測系統,使得神經重症病人臨床結果更進步,是未來研究主要的方向。 |
英文摘要 | The goals of modern neurosurgical intensive care are not only to resuscitate the brain function but also to provide the patient relief from anxiety and discomfort. Sedation and paralysis had become an integral part of critical care. Although over-sedation and prolonged paralysis may result in prolonged mechanical ventilation use, ICU stay, weakness and increased cost, adequate sedation can decrease the metabolic rate, sympathetic tone and there fore oxygen demand, facilitate ventilator use and provide better intracranial pressure control that resulted in better cerebral perfusion and prevent cerebral ischemia. The common used sedatives, propofol midazolam and lorazepam were similar in efficacy, and safety. But lorazepam appears to be the most cost-effective choice. The common used neuromuscular blockades are pancuronium, vecuronium and attracurium. The short-acting neuromuscular blockade is easy to titration and without accumulation but is more expensive. Proper use of sedatives and neuromuscular blockade is based on the knowledge of the medication. A guideline and appropriate monitor system to evaluate the result are needed to facilitate improving the outcome of the neurosurgical treatment. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。