儿童患者手术室外的程序镇静
- Authors
- Deborah C Hsu, MD, MEd
Deborah C Hsu, MD, MEd
- Associate Professor of Pediatrics, Section of Emergency Medicine
- Baylor College of Medicine
- Joseph P Cravero, MD
Joseph P Cravero, MD
- Associate Professor of Anesthesia
- Harvard Medical School
- Boston Children's Hospital
- Section Editors
- Anne M Stack, MD
Anne M Stack, MD
- Section Editor — Pediatric Procedures
- Associate Professor, Department of Pediatrics
- Harvard Medical School
- Adrienne G Randolph, MD, MSc
Adrienne G Randolph, MD, MSc
- Section Editor — Pediatric Critical Care Medicine
- Professor of Anaesthesia and Pediatrics
- Harvard Medical School
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
- Translators
- 杨文燕, 主任医师
杨文燕, 主任医师
- 昆明医科大学第一附属医院麻醉科
引言
在对儿童患者进行诊疗操作时，如果患儿安静不动且其疼痛和焦虑均得到有效控制，则操作会更安全且更易成功。为此，通常需要采用药物和非药物干预，同时要考虑儿童的发育情况和临床环境。另外，注意处理患儿病情相关的疼痛和焦虑，也是使治疗可接受且富有同情心的必要条件。美国儿科学会的一份临床报告强调了关于急诊医疗系统中处理疼痛和焦虑的重要性的具体问题[1]。
随着可用的短效镇静剂越来越多，加上准确的无创监护以及镇静培训项目已有改善，在手术室外也能安全且有效地实施镇静和镇痛[2]。程序镇静是一个不断发展的领域，由多学科的医师团队实施，应用于越来越多的临床情况[3]。必须解决的难题之一就是对患者结局给出统一的定义，尤其是关于什么是令人满意的镇静，以及什么是不良事件。此外，现在仍有很多镇静指南是由各个专科学会制定的。制定统一的指南将促进各专科采取一致的镇静[4]。
本专题将总结为儿童进行诊疗操作时实施程序镇静的适应证、禁忌证及安全实施的步骤，不考虑具体情况。
镇静前的评估、程序镇静的准备、用于儿童程序镇静的具体药物的特性、选择儿童程序镇静药物的策略、儿童气道管理，以及成人镇静将单独讨论。
●(参见“儿科手术室外程序镇静的准备”)
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