目标不等于目的——浅谈镇痛镇静的器官保护作用

镇痛镇静治疗的目的在于保护器官的形态与功能储备。在能够满足全身各组织器官代谢最低需求的循环灌注与氧合的基础上,让器官尽量休息且功能和谐匹配,以最大限度地节约和保护器官的储备功能,使得危重患者康复后能够尽可能保持较好的生活质量,是重症医学可持续发展的重要基础。在达到镇痛镇静治疗目的的过程中,需要根据患者的病情、基础状态、器官功能等个体化设置不同的镇痛镇静目标,而不宜简单机械地强调“深镇静”或“浅镇静”。镇痛镇静治疗是一把双刃剑,无监测,勿镇痛镇静;实施镇痛镇静治疗时需要对治疗是否已顺序达到镇痛镇静目标,并趋近器官功能保护目的进行连续的监测与评估,但此监测与评估不能仅局限于对患者疼痛和意识及认知状态的了解,还必须包括对患者基本生命体征的动态变化以及器官功能的储备代偿能力判断,运用监测评估的手段,使机体各器官达到休整生息、尽量多保留储备功能、减少慢重症、提高生活质量之目的。

Reaching the standard does not mean achieving the aim –the most important role of analgesia and sedation in organs

The aim of analgesia and sedation treatment is to protect the morphology and functional reserve of organs. On the basis of circulatory perfusion and oxygenation, which can meet the minimum requirement of body and organ metabolism in the whole body, the organs can be rest and function harmoniously, so as to save and protect the organ’s reserve function to the maximum extent, so that the critically ill patients can maintain good living quality as much as possible after the rehabilitation. It will be very important for the sustainable development of critical care medicine. In the process of achieving the purpose of analgesic and sedative therapy, it is necessary to set up different analgesic sedative targets according to the patient’s condition, basic state and organ function. It is not suitable to simply and mechanically emphasize "deep sedation" or "light sedation". Analgesic and sedative treatment is a double-edged sword. No monitoring, no analgesia and sedation. To give the optimal analgesia and sedation therapy, it requires continuous monitoring and evaluation of whether the treatment is in order to achieve analgesic and sedative targets and to reach the purpose of protecting organ function. However, the monitoring and evaluation should not only be limited to the understanding of pain and consciousness and cognition, but also the dynamic changes in the basic vital signs of patients. By means of monitoring and evaluation, we can achieve the goal of keeping all organs of the body alive, preserving function as much as possible, reducing chronic and critical illness and improving the quality of life in patients.