依据人体正常作息调整镇静药物使用对ICU机械通气患者的效果分析
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摘要
目的分析依据人体正常作息调整镇静药物使用对重症加强护理病房(ICU)机械通气患者的临床应用效果,为其合理用药提供参考。方法选取2016年1月—2017年1月在金华市人民医院诊断且符合纳入标准的60例ICU机械通气患者为研究对象,采用随机数字表法将其分为观察组和对照组,每组各30例,对照组患者采用常规干预模式进行治疗,观察组患者依据人体正常作息调整镇静药物的使用,运用Ricker镇静-躁动评分量表(SAS)及重症监护疼痛评分量表(CPOT)对机械通气患者的镇静镇痛深度进行控制,比较2组患者谵妄等不良反应发生率及临床指标(通气时间、ICU治疗时间、收缩压、舒张压、心率、动脉血氧饱和度)间的差异。结果观察组患者的VAP发生率显著低于对照组(P<0.05),观察组患者的通气时间、ICU治疗时间、收缩压、舒张压、心率以及芬太尼、丙泊酚和右美托咪定用量均明显低于对照组(均P<0.05),其动脉血氧饱和度(Sa O2)水平明显高于对照组(P<0.05)。结论依据人体正常作息调整镇静药物的使用可以显著降低患者不良反应发生率,改善患者临床相关指标水平,对ICU机械通气患者的治疗具有较高的临床应用价值。
Objective To analyze the clinical application of sedative drugs in Intensive Care Unit(ICU) patients with mechanical ventilation based on normal rest,to provide a referencefor its clinical care.Methods Sixty patients with ICU mechanical ventilation who were diagnosed and met in our hospital in January 2016 and January 2017 were divided into observation group(30 cases) and control group(30 cases) according to the random number table method.The patients in the control group were treated with routine intervention mode.The patients in the observation group adjusted the use of sedative drugs according to the normal rest.The sedative and analgesic depth of patients with mechanical ventilation was controlled by the Ricker Sedation-Agitation Scale(SAS) and the Critical-care Pain Observation Tool(CPOT).Comparison of the incidence of adverse events(ventilation time,ICU treatment time,systolic blood pressure,diastolic blood pressure,heart rate,arterial oxygen saturation) and the differences of the clinical indicators between the subgroups.Results The incidence of VAP in the observation group was significantly lower than that in the control group(P < 0.05).The level of arterial oxygen saturation(Sa O2) of observation group were significantly higher than those of control group(all P < 0.05).The ventilation time,ICU treatment time,systolic blood pressure,diastolic blood pressure,heart rate and the dosage of fentanyl,propofol and dexmedetomidine in observation group were significantly lower than those of control group(P < 0.05).Conclusion According to the normal rest to adjust the use of sedative drugs can significantly reduce the incidence of adverse reactions and improve the level of clinical indicators of patients,which has high clinical value in the treatment of ICU patients with mechanical ventilation.
Objective To analyze the clinical application of sedative drugs in Intensive Care Unit(ICU) patients with mechanical ventilation based on normal rest,to provide a referencefor its clinical care.Methods Sixty patients with ICU mechanical ventilation who were diagnosed and met in our hospital in January 2016 and January 2017 were divided into observation group(30 cases) and control group(30 cases) according to the random number table method.The patients in the control group were treated with routine intervention mode.The patients in the observation group adjusted the use of sedative drugs according to the normal rest.The sedative and analgesic depth of patients with mechanical ventilation was controlled by the Ricker Sedation-Agitation Scale(SAS) and the Critical-care Pain Observation Tool(CPOT).Comparison of the incidence of adverse events(ventilation time,ICU treatment time,systolic blood pressure,diastolic blood pressure,heart rate,arterial oxygen saturation) and the differences of the clinical indicators between the subgroups.Results The incidence of VAP in the observation group was significantly lower than that in the control group(P < 0.05).The level of arterial oxygen saturation(Sa O2) of observation group were significantly higher than those of control group(all P < 0.05).The ventilation time,ICU treatment time,systolic blood pressure,diastolic blood pressure,heart rate and the dosage of fentanyl,propofol and dexmedetomidine in observation group were significantly lower than those of control group(P < 0.05).Conclusion According to the normal rest to adjust the use of sedative drugs can significantly reduce the incidence of adverse reactions and improve the level of clinical indicators of patients,which has high clinical value in the treatment of ICU patients with mechanical ventilation.
引文
[1]王翠婷,董晨明,张虹,等.模拟人体生物钟镇静用于ICU机械通气患者的临床研究[J].护理学杂志,2017,32(2):19-23.
[2]赵华,吴健,杨爱祥,等.模拟人体生物钟镇静对ICU机械通气病人谵妄发生的影响[J].临床和实验医学杂志,2017,16(4):396-399.
[3]莫毅,刘俊,刘端绘,等.镇静镇痛治疗在ICU内机械通气患者中的应用研究[J].黑龙江医学,2016,40(12):1083-1084.
[4]卢广轩,覃炳军,安曙光,等.全程镇静模拟人体生物钟模式在ICU机械通气患者中的应用[J].国际医药卫生导报,2017,23(12):1866-1868.
[5]HAN J H,VASILEVSKIS E E,SCHNELLE J F,et al.The diagnostic performance of the richmond agitation sedation scale for detecting delirium in older emergency department patients[J].Acad Emerg Med,2015,22(7):878.
[6]陈哲奇,江荣林,徐琼,等.自主呼吸试验安全性筛查宽松标准在ICU撤机中应用效用及安全性研究[J].中国实用内科杂志,2014,34(5):495-498.
[7]卜克,刘林刚,张娆娆.不同镇静程度在成人ICU机械通气患者中的回顾性分析[J].临床荟萃,2017,32(9):778-781.
[8]李远华,戚应静,吴苏华,等.右美托咪啶在慢性阻塞性肺疾病急性加重期患者脱机后镇静作用临床研究[J].国际医药卫生导报,2015,21(15):2233-2235.
[9]李俊艳,董晨明,张虹,等.模拟人体生物钟镇静在重症加强治疗病房机械通气谵妄防控中的研究[J].中华危重病急救医学,2016,28(1):50-56.
[10]DALE C R,KANNAS D A,FAN V S,et al.Improved analgesia,sedation,and delirium protocol associated with decreased duration of delirium and mechanical ventilation[J].Ann Am Thorac Soc,2014,11(3):367-374.
[11]FAUST A C,RAJAN P,SHEPERD L A,et al.Impact of an analgesiabased sedation protocol on mechanically ventilated patients in a medical intensive care unit[J].Anesthesia,2016,123(4):903.
[12]巫建芳,廖彧,龙贵华,等.镇静镇痛方案在ICU清醒危重症患者机械通气的临床比较观察[J].国际医药卫生导报,2014,20(23):3611-3613.
[13]徐建宁,汪国建,冯洁惠.早期目标导向型镇静用于ICU机械通气患者的效果评价[J].护理学杂志,2016,31(10):25-28.
[14]KUDCHADKAR S R,YASTER M,PUNJABI N M.Sedation,sleep promotion,and delirium screening practices in the care of mechanically ventilated children:a wake-up call for the pediatric critical care community[J].Crit Care Med,2014,42(7):1592-1600.
[15]蒋良艳,汤展宏.ICU镇痛镇静药物的合理使用[J].中华重症医学电子杂志(网络版),2017,3(4):262-265.
[16]刘燕萍,刘捃.成立护理质量管理小组对提高护理质量的影响研究[J].航空航天医学杂志,2016,27(12):1601-1603.
[17]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.
[18]孙婷,韩芳,孙运良,等.重症监护病房谵妄患者24 h连续睡眠监测及褪黑素动态水平变化的研究[J].中华危重病急救医学,2014,26(10):726-729.
[19]唐晓琴.以护理为主导实施的镇静镇痛方案对机械通气重症肺炎患者的临床研究[J].实用医学杂志,2014,30(16):2669-2671.
[20]MESSERSCHMIDT K.Melatonin supplementation to prevent delirium in hospitalized elderly patients[J].S D Med,2016,69(6):274.
[21]吴艳梅.高龄患者术后谵妄发生原因分析及护理进展[J].当代护士(下旬刊),2014,21(10):13-15.
[2]赵华,吴健,杨爱祥,等.模拟人体生物钟镇静对ICU机械通气病人谵妄发生的影响[J].临床和实验医学杂志,2017,16(4):396-399.
[3]莫毅,刘俊,刘端绘,等.镇静镇痛治疗在ICU内机械通气患者中的应用研究[J].黑龙江医学,2016,40(12):1083-1084.
[4]卢广轩,覃炳军,安曙光,等.全程镇静模拟人体生物钟模式在ICU机械通气患者中的应用[J].国际医药卫生导报,2017,23(12):1866-1868.
[5]HAN J H,VASILEVSKIS E E,SCHNELLE J F,et al.The diagnostic performance of the richmond agitation sedation scale for detecting delirium in older emergency department patients[J].Acad Emerg Med,2015,22(7):878.
[6]陈哲奇,江荣林,徐琼,等.自主呼吸试验安全性筛查宽松标准在ICU撤机中应用效用及安全性研究[J].中国实用内科杂志,2014,34(5):495-498.
[7]卜克,刘林刚,张娆娆.不同镇静程度在成人ICU机械通气患者中的回顾性分析[J].临床荟萃,2017,32(9):778-781.
[8]李远华,戚应静,吴苏华,等.右美托咪啶在慢性阻塞性肺疾病急性加重期患者脱机后镇静作用临床研究[J].国际医药卫生导报,2015,21(15):2233-2235.
[9]李俊艳,董晨明,张虹,等.模拟人体生物钟镇静在重症加强治疗病房机械通气谵妄防控中的研究[J].中华危重病急救医学,2016,28(1):50-56.
[10]DALE C R,KANNAS D A,FAN V S,et al.Improved analgesia,sedation,and delirium protocol associated with decreased duration of delirium and mechanical ventilation[J].Ann Am Thorac Soc,2014,11(3):367-374.
[11]FAUST A C,RAJAN P,SHEPERD L A,et al.Impact of an analgesiabased sedation protocol on mechanically ventilated patients in a medical intensive care unit[J].Anesthesia,2016,123(4):903.
[12]巫建芳,廖彧,龙贵华,等.镇静镇痛方案在ICU清醒危重症患者机械通气的临床比较观察[J].国际医药卫生导报,2014,20(23):3611-3613.
[13]徐建宁,汪国建,冯洁惠.早期目标导向型镇静用于ICU机械通气患者的效果评价[J].护理学杂志,2016,31(10):25-28.
[14]KUDCHADKAR S R,YASTER M,PUNJABI N M.Sedation,sleep promotion,and delirium screening practices in the care of mechanically ventilated children:a wake-up call for the pediatric critical care community[J].Crit Care Med,2014,42(7):1592-1600.
[15]蒋良艳,汤展宏.ICU镇痛镇静药物的合理使用[J].中华重症医学电子杂志(网络版),2017,3(4):262-265.
[16]刘燕萍,刘捃.成立护理质量管理小组对提高护理质量的影响研究[J].航空航天医学杂志,2016,27(12):1601-1603.
[17]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.
[18]孙婷,韩芳,孙运良,等.重症监护病房谵妄患者24 h连续睡眠监测及褪黑素动态水平变化的研究[J].中华危重病急救医学,2014,26(10):726-729.
[19]唐晓琴.以护理为主导实施的镇静镇痛方案对机械通气重症肺炎患者的临床研究[J].实用医学杂志,2014,30(16):2669-2671.
[20]MESSERSCHMIDT K.Melatonin supplementation to prevent delirium in hospitalized elderly patients[J].S D Med,2016,69(6):274.
[21]吴艳梅.高龄患者术后谵妄发生原因分析及护理进展[J].当代护士(下旬刊),2014,21(10):13-15.