A Guide to Intensive Care Unit (2)

ICU指南(2)

The Patients

ICU病人

Patients are admitted to the intensive care unit either because they require high-intensity monitoring and life support by specially trained health care providers or because they require high-intensity nursing care that cannot be provided on a general medical or surgical ward. As noted previously, surgical patients are admitted to the surgical intensive care unit and medical patients to the medical or coronary intensive care units.

病人进入ICU，有的是因为需要由经过特殊训练的健康护理人员进行高强度监护和生命支持，有的是因为其他普通内科或外科病房无法提供病人所需要的高强度护理。如前所述，外科病人进入外科ICU，内科病人进入内科或冠心病ICU。

Many surgical patients are admitted with medical problems such as pneumonia or sepsis.

许多外科病人都是因为一些内科疾病，如肺炎、浓毒症等，而住进来的。

Patients come to the ICU from several areas

ICU病人来自不同科室

Operating room (OR) or post-anesthesia care unit (PACU) -- Surgical patients who require invasive monitoring, mechanical ventilation, or resuscitation after surgery may be transported directly to the ICU from the OR or the PACU after a period of observation. Such direct transport is considered a transfer from one critical care area to another. Therefore, their ICU management is a continuation of care that they received from the anesthesiology team in the operating room or PACU.

手术室(OR)或麻醉后监护病房(RACU)—术后需要侵入性监测、机械通气或复苏的病人，在经过一段时间观察后就可以直接从手术室或麻醉后监护病房送到ICU。人们将这种直接运送看作是危重病护理区之间的转科，因此，其ICU处理也就是OR或PACU麻醉小组的护理继续。

Emergent care center (ECC) or emergency room -- Medical, surgical, trauma, or burn patients can be admitted to the ICU from the ECC or emergency room. These patients typically undergo a series of diagnostic tests prior to their transfer, and the etiology of their illness may or may not be known by the time they come to the ICU. They are admitted to manage their acute illness.

急诊护理中心(ECC)或急诊室—内科、外科、创伤或灼伤病人可以从ECC或急诊室住进ICU。这些病人在转来之前通常都做过一系列的诊断检查，转来ICU时，他们的病因可能已经知道，也可能还不知道。他们是到ICU来处理急病的。

Medical or surgical ward -- Patients may be admitted to the ICU from a general medical or surgical ward. These are patients who were initially stable but who developed respiratory distress, low blood pressure, shock, cardiopulmonary arrest, or other physiologic instabilities on the ward. They require aggressive resuscitation, treatment, and invasive monitoring and are transferred to the ICU for closer observation, more frequent measurement of vital signs, invasive monitoring, or mechanical ventilation.

内科或外科病房—病人可以从普通内科或外科病房收住ICU。这些病人开始时的病情都很稳定，但在病房治疗时发生了呼吸窘迫、低血压、休克、心肺停止或其他的生理不稳定情况，需要超常规的复苏、治疗和侵入性监护，因此被转到ICU接受更密切的观察、增加生命体征测量、采取侵入性监护或进行机械通气。

Other facilities -- Patients may also be transferred from another facility that does not have the resources to provide the level or type of care they require.

其他机构—病人也可以是从另一个机构转到这里，因为该机构没法提供所需的护理。

Common Reasons for Admission to the ICU

ICU入院常见原因

Respiratory compromise--Patients with respiratory distress, manifested either as an inability to oxygenate or an inability to ventilate, are transferred to the ICU for supplemental oxygen and mechanical ventilation. Etiologies of respiratory distress are numerous and include pneumonia, acute respiratory distress syndrome, pulmonary embolism, and exacerbations of chronic obstructive lung disease.

呼吸系统损伤—呼吸窘迫病人可表现为无法氧合或通气不能，转到ICU就是为了补充氧气、机械通气。呼吸窘迫病因很多，包括肺炎、急性呼吸窘迫综合症、肺栓塞和慢性阻塞性肺部疾病等。

Hemodynamic compromise--Patients with hemodynamic instability are admitted for management of arrhythmias, hypotension, or hypertension. Patients with hypotension are typically resuscitated with fluid or medications (e.g., vasopressors or inotropes) to increase vascular tone. If a predetermined minimal mean blood pressure cannot be maintained, or if the patient has signs of inadequate oxygen delivery to the tissues (i.e., altered mental status, decreased urine output, cool skin, and lactic acidosis), a pulmonary artery catheter (PAC) may be inserted to monitor cardiac output. Measurements obtained from the PAC aid the clinician in deciding, for example, whether to treat the patient with more fluids to improve preload—the filling pressure of the left ventricle--or to initiate inotropes to improve contractility. In these instances, an arterial catheter is often inserted to monitor systemic blood pressure continuously. Patients with severe hypertension are generally managed with titratable intravenous medications.

血液动力学功能损伤—血液动力学功能不稳病人收住ICU以处理心律失常、低血压或高血压。低血压病人主要是通过液体或药物进行复苏(如血管升压类药物或收缩性药物)，增加血管张力。如果无法保持预定的最低平均血压，如果病人出现组织供氧不足症状(如精神状态改变、排尿量减少、皮肤发冷和乳酸性酸中毒)，就可能需要施行肺动脉插管(PAC)以监测心排血量。PAC测量结果可以帮助临床医生做出决定，如是否需要增加输液改善前负荷—即左室充盈压—或使用收缩性药物以提高收缩性。在上述情况中，常常要通过动脉插管来连续监测体循环血压。有严重高血压的病人通常采用可滴定静脉给药法进行处理。

Myocardial ischemia or infarction -- Patients with inadequate oxygen delivery to their myocardium are admitted for the management of angina and myocardial infarction. They may require titration of nitroglycerin, beta blockers, and morphine. Each medication can result in further complications such as hypotension, decreased heart rate, bronchospasm, or decreased respiratory drive, respectively. These patients are often candidates for thrombolytic agents and cardiac catheterization. The goal of admission, to reverse ischemia and minimize myocardial injury, requires close monitoring and rapid intervention. 医学全在线www.med126.com

心肌缺血或梗死—心肌供氧不足病人入院处理心绞痛或心肌梗死。这些病人可能需要甘油滴定、β-阻止剂或吗啡。每种药物都可能导致进一步的并发症，如低血压、心率减慢、支气管痉挛或呼吸动力减弱等。这些病人常常是血栓溶解剂和心导管插管的使用对象。收治目的是逆转心肌缺血减少心肌损伤，这需要密切的监护，并迅速采取措施。

Neurological compromise -- Patients with alterations in mental status are admitted to the ICU for frequent neurologic checks. If their condition deteriorates, they may need to have an endotracheal tube placed to protect their airway.

神经损伤—精神状态变化病人住进ICU进行频繁的神经检查。如果病情恶化，就可能需要放置气管内插管以保护气道。 医学全.在线提供

Gastrointestinal -- Patients with life-threatening gastrointestinal bleeding are admitted to treat hypotension with IV fluids, blood and blood products. Diagnostic tests such as endoscopy will likely be performed to locate and treat the source of bleeding in unstable patients in the ICU.

胃肠—出现危及性命的胃肠出血病人住进ICU，通过IV输液、全血或血液制品治疗低血压。有可能在ICU通过内窥镜之类的诊断检查来定位和治疗不稳定病人的出血。

Renal and metabolic -- Patients may be admitted for treatment of the complications of renal failure, including acidosis, volume overload, and electrolyte abnormalities. More often, patients develop renal failure in the ICU secondary to hypotension and sepsis. Treatment with careful attention to acid-base balance, electrolytes, and volume status is provided in the ICU. Other metabolic crises, such as hypercalcemia, unrelated to renal failure, may result in a patient's admission to the ICU.

肾和代谢问题—病人入院也可能是为了治疗肾衰引发的各种并发症，包括酸中毒、容量过度负荷、电解质异常等。更常见的情况是，病人在ICU时因低血压和脓毒症而继发肾衰。ICU治疗时应密切注意酸碱平衡、电解质和容积状况。其他代谢性危象如高钙血症等，尽管与肾衰无关，但也可能导致病人收住 ICU。

Postoperative -- There are many reasons for admitting patients to the ICU. They may still be on a ventilator, or they may have other invasive monitoring. They may have a history of coronary artery disease and therefore be at risk for a perioperative MI. They may have had extensive bleeding and require frequent observation. They may have had an extensive surgical procedure, including open-heart surgery, organ transplantation, vascular surgery, or general abdominal surgery. Each surgical intervention has specific perioperative issues that require observation and treatment in the ICU. Patients with trauma, orthopedic injuries, and extensive thermal injuries are also admitted to ICUs.

术后—很多原因可以使病人住进ICU。他们可能仍在使用呼吸机，也可能是在接受其他入侵性监测。他们可能有冠状动脉疾病史，因此有围手术期心肌梗死危险。病人也可能有大出血，需要密切观察。病人可能接受过大型外科手术，如开胸手术、器管移植、血管手术、或腹部手术。每次手术都有特定的围手术期问题需要在ICU进行观察和治疗。创伤、骨伤和大面积热损伤病人也会收住ICU。

Transporting the Patient to the ICU：

运送病人到ICU

Once it is clear that a patient requires management in the intensive care unit, the ICU personnel should be notified. An attending, fellow, or resident should call the ICU charge nurse and indicate the patient's name, illness, reason for transfer to the ICU, and immediate plans for treatment. Alerting the staff in the ICU prior to patient transport allows them to prepare for the patient's arrival. Advance communication with the ICU physician ensures that the appropriate support is available when the patient arrives. It is essential that the appropriate personnel, equipment, and monitors are available for all transfers to the ICU.

一旦明确病人需要由ICU处理，就应通知ICU医护人员。由主治医师、普通医生或住院医师呼叫ICU主管护师，弄清病人的姓名、疾病、转科原因，立即制订治疗计划。在病人送到前提醒ICU工作人员，使他们为病人到来作好准备。事先与ICU医师沟通可确保病人到达时得到合适的支持。使转到ICU的所有病人都有合适的人手、器械和监护，这一点极为重要。