危重症患儿最佳镇静水平动态评估和实时监测的研究进展

doi:10.3761/j.issn.2096-7446.2023.02.019

摘要/Abstract

摘要： 对镇静水平进行动态评估和实时监测是危重症儿童达到最佳镇静水平的必要环节。该文综述了危重症儿童镇静评估工具的选择、最佳镇静水平范围、镇静评估的时机和频率,以及镇静药物使用和镇静时生理状态的监测。患儿镇静状态和生理指标的动态评估和实时监测能使患儿更迅速、更安全地达到最佳镇静水平,但统一的标准和规章制度需进一步建立和完善。

关键词: 危重病, 儿童, 镇静, 评估, 监测, 综述文献（主题）

Abstract: Dynamic assessment and real-time monitoring of sedation levels is a necessary part of achieving optimal sedation levels in critically ill children. This article reviews the selection of sedation assessment tools for critically ill children,the range of optimal sedation levels,the timing and frequency of sedation assessment,and the use of sedative medications,and the monitoring of physiologic status during sedation. Dynamic assessment and real-time monitoring of the child's sedation status and physiological indicators can enable the children to achieve optimal sedation levels more rapidly and safely,but uniform standards and regulations need to be further established and improved.

Key words: Critical Illness, Child, Sedation, Assessment, Monitoring, Review Literature as Topic

王馨芝, 楼晓芳. 危重症患儿最佳镇静水平动态评估和实时监测的研究进展[J]. 中华急危重症护理杂志, 2023, 4(2): 184-188.

WANG Xinzhi, LOU Xiaofang. Research progress on dynamic assessment and real-time monitoring of optimal sedation levels in critically ill children[J]. Chinese Journal of Emergency and Critical Care Nursing, 2023, 4(2): 184-188.

参考文献

[1] Egbuta C,Mason KP.Current state of analgesia and sedation in the pediatric intensive care unit[J]. J Clin Med,2021,10(9):1847.
[2] Hagstrom S,Hall J,Sakhitab-Kerestes A,et al.Pediatric critical care nurses' practices related to sedation and analgesia[J]. Dimens Crit Care Nurs,2021,40(5):280-287.
[3] Sperotto F,Mondardini MC,Dell'Oste C,et al. Efficacy and sa-fety of dexmedetomidine for prolonged sedation in the PICU:a prospective multicenter study(PROSDEX)[J]. Pediatr Crit Care Med,2020,21(7):625-636.
[4] Vet NJ,Kleiber N,Ista E,et al.Sedation in critically ill children with respiratory failure[J]. Front Pediatr,2016,4:89.
[5] Practice guidelines for moderate procedural sedation andanalgesia 2018:a report by the American Society of Anesthesiologists Task Force on Moderate Procedural Sedation and Analgesia,the American Association of Oral and Maxillofacial Surgeons, American College of Radiology,American Dental Association, American Society of Dentist Anesthesiologists, and Society of Interventional Radiology[J]. Anesthesiology,2018,128(3):437-479.
[6] Harris J,Ramelet AS,van Dijk M,et al. Clinical recommendations for pain,sedation,withdrawal and delirium assessment in critically ill infants and children:an ESPNIC position statement for healthcare professionals[J]. Intensive Care Med,2016, 42(6):972-986.
[7] 中华医学会儿科学分会急救学组,中华医学会急诊医学分会儿科学组,中国医师协会儿童重症医师分会. 中国儿童重症监护病房镇痛和镇静治疗专家共识(2018版)[J]. 中华儿科杂志,2019,57(5):324-330.
The Emergency Group of Pediatrics Branch of Chinese Medical Association,Pediatrics Group of Emergency Medicine Branch of Chinese Medical Association,Pediatric Critical Care Branch of Chinese Medical Doctor Association. Consensus on sedation and analgesia for children in pediatric intensive care unit of China(2018)[J]. Chin J Pediatr,2019,57(5):324-330.
[8] Bosch-Alcaraz A,Tamame-San Antonio M,Luna-Castaño P,et al. Specificity and sensibility of the Spanish version of the COMFORT Behaviour Scale for assessing pain,grade of sedation and withdrawal syndrome in the critically ill paediatric patient. Multicentre COSAIP study(Phase 1)[J]. Enferm Intensiva(Engl Ed),2022,33(2):58-66.
[9] van Dijk M,Peters JW,van Deventer P,et al. The COMFORT Behavior Scale:a tool for assessing pain and sedation in infants[J]. Am J Nurs,2005,105(1):33-36.
[10] 张婉莹,戴燕红,金花,等. 儿童镇静程度评估工具的研究进展[J]. 中华护理杂志,2021,56(11):1644-1648.
Zhang WY,Dai YH,Jin H,et al.Research progress of assessment tools for the level of pediatric sedation[J]. Chin J Nurs, 2021,56(11):1644-1648.
[11] Tapia R,López-Herce J,Arias á,et al.Validity and reliability of the Richmond agitation-sedation scale in pediatric intensive care patients:a multicenter study[J]. Front Pediatr,2021, 9:795487.
[12] Namigar T,Serap K,Esra AT,et al.The correlation among the Ramsay sedation scale,Richmond agitation sedation scale and Riker sedation agitation scale during midazolam-remifentanil sedation[J]. Rev Bras Anestesiol,2017,67(4):347-354.
[13] 钟琳,陈莉娜,陈婷,等. 镇静躁动评分在儿童支气管镜术前镇静中的应用[J]. 中国内镜杂志,2018,24(2):1-5.
Zhong L,Chen LN,Chen T,et al.Application of sedation-agitation scale in children's conscious sedation before broncoscopy examination[J]. China J Endosc,2018,24(2):1-5.
[14] Hoshino H,Sakuramoto H,Matsuishi Y,et al.Development of the Japanese version of the State Behavioral Scale for critically ill children[J]. Acute Med Surg,2019,6(2):101-108.
[15] 李春香,龚霄雷,朱丽敏,等. 脑电双频指数监测在先天性心脏病患儿术后镇静中的效果评价[J]. 中国小儿急救医学,2021(6):511-515.
Li CX,Gong XL,Zhu LM,et al.The sedative effect after congenital heart disease surgery in children under the bi-spectral index monitoring[J]. Chin Pediatr Emerg Med,2021(6):511-515.
[16] Arenas-López S,Riphagen S,Tibby SM,et al.Use of oral clonidine for sedation in ventilated paediatric intensive care patients[J]. Intensive Care Med,2004,30(8):1625-1629.
[17] Zalieckas J,Weldon C.Sedation and analgesia in the ICU[J]. Semin Pediatr Surg,2015,24(1):37-46.
[18] 朱利娟,赵燕,朱颖,等. 基于Ramsay镇静评分护理干预在儿童连续性肾脏替代治疗过程中的应用效果[J]. 中华现代护理杂志,2019(17):2116-2119.
Zhu LJ,Zhao Y,Zhu Y,et al.Nursing intervention based on Ramsay sedation score in continuous renal replacement therapy of children[J]. Chin J Mod Nurs,2019(17):2116-2119.
[19] Cunningham ME,Vogel AM.Analgesia,sedation,and delirium in pediatric surgical critical care[J]. Semin Pediatr Surg,2019,28(1):33-42.
[20] 李茜,王丽竹,邵清,等. 机械通气患者镇静早期深镇静发生情况及危险因素分析[J]. 护理与康复,2022,21(1):7-11.
Li Q,Wang LZ,Shao Q,et al.Status of deep sedation in early sedation stage for patients with mechanical ventilation and analysis on risk factors[J]. J Nurs Rehabil,2022,21(1):7-11.
[21] Giovannitti JA Jr,Thoms SM,Crawford JJ.Alpha-2 adrenergic receptor agonists:a review of current clinical applications[J]. Anesth Prog,2015,62(1):31-39.
[22] 杨明全,郑刚,周传正,等. 咪达唑仑联合氯胺酮急诊危重患者气管插管镇静对血压的影响[J]. 中国急救医学,2013(4):326-329.
Yang MQ,Zheng G,Zhou CZ,et al.Midazolam combined ketamine sedation in emergency intubation in critically ill patients and its effect on blood pressure[J]. Chin J Crit Care Med,2013(4):326-329.
[23] Frölich MA,Banks C,Ness TJ.The effect of sedation on cortical activation:a randomized study comparing the effects of sedation with midazolam,propofol,and dexmedetomidine on auditory processing[J]. Anesth Analg,2017,124(5):1603-1610.
[24] Wang FH,Zhang J,Xiao M,et al.Sedative effect of intranasal midazolam in neonates undergoing magnetic resonance imaging:a prospective single-blind randomized controlled study[J]. Chin J Contemp Pediatr,2020,22(5):441-445.
[25] Weissman C.Sedation and neuromuscular blockade in the ICU[J]. Chest,2005,128(2):477-479.
[26] 张婉莹,董丽,戴燕红,等. 小儿镇静监测的最佳证据总结[J]. 中国实用护理杂志,2021,37(35):2763-2769.
Zhang WY,Dong L,Dai YH,et al.Summary of the best evidence for sedation monitoring in children[J]. Chin J Pract Nurs, 2021,37(35):2763-2769.