RASS与SAS镇静评分在AECOPD有创机械通气患者中的应用分析  

Analysis of RASS and SAS Sedation Scores in Patients with Invasive Mechanical Ventilation with AECOPD

作　　者：刘晓彤 辛怡明 张红媛 熊民兴 程爱斌 LIU Xiao-tong;XIN Yi-ming;ZHANG Hong-yuan;XIONG Min-xing;CHENG Ai-bin(Department of Critical Care Medicine,Hospital of North China University of Science and Technology,Tangshan Hebei)

机构地区：[1]华北理工大学附属医院重症医学科,河北 唐山

出　　处：《世界最新医学信息文摘》2020年第26期25-27,共3页World Latest Medicine Information Electronic Version

摘　　要：目的 对比应用RASS镇静评分与SAS镇静评分评估慢性阻塞性肺疾病急性加重期行有创机械通气患者的镇静深度的临床效果的影响.方法 选取入住ICU明确诊断为AECOPD同时需有创机械通气治疗的患者80例,随机分为两组,实施以浅镇静为目标导向的程序化镇静与每日唤醒相结合的镇静策略,分别采用RASS评分、SAS评分指导镇静治疗.记录两组的生命体征、呼吸动力学指标及动脉血PaCO2、镇痛、镇静药物应用剂量、镇静时间、有创机械通气时间、带管时间、ICU 住院时间及不良事件的发生例数.结果 与T0比较,两组患者各时间的各项研究指标均呈好转趋势;R组在T2-T5时MAP、HR均高于与S组,在T3-T5时f、Vt均高于S组,在T4、T5时间点Raw、PaCO2均小于S组,在T5时P/F大于S组;R组较S组患者镇静药物用量、有创机械通气时间、带管时间、ICU停留时间均明显减少,镇静过度情况发生较少, VAP、DVT的发生率较低.结论 对于AECOPD行有创机械通气的患者,采用RASS评分指导镇静治疗较SAS评分更为有益,能够减少镇静药用量,缩短插管时间及ICU停留时间,改善短期预后.Objective Contrast application RASSscores and SASscore assessment of acute exacerbation of chronic obstructive pulmonary disease period influence on the clinical effect of sedation depth in patients undergoing invasive mechanical ventilation.Methods 80 patients admitted to the ICU who were diagnosed as AECOPD and required invasive mechanical ventilation were randomly divided into two groups.The sedation strategy of combining programmed sedation with daily wake up,which was targeted at shallow sedation,was implemented.RASS and SAS score were used to guide the sedation treatment respectively.Vital signs,respiratory dynamics indexes,application dose of arterial blood PaCO2,analgesia,sedative drugs,sedation duration,invasive mechanical ventilation duration,tube duration,ICU hospitalization duration and incidence of adverse events in the two groups were recorded.Results Compared with T0,the indexes of the two groups showed an improved trend at each time.At T2-T5,MAP and HR in group R were higher than those in group S;at T3-T5,f and Vt were higher than those in group S;at time points T4 and T5,Raw and PaCO2 were lower than those in group S;at T5,P/Fwas higher than that in group S.Compared with group S,the dosage of sedation drugs,invasive mechanical ventilation time,tube time and ICU stay time of patients in group R were significantly reduced,with fewer cases of excessive sedation and lower incidence of VAP and DVT.Conclusion For patients undergoing invasive mechanical ventilation in AECOPD,RASS score is more beneficial than SAS score in guiding sedation treatment,which can reduce the dosage of sedatives,shorten the duration of intubation and ICU stay,and improve short-term prognosis.

关 键 词：慢性阻塞性肺疾病 急性加重期 镇静评分 有创机械通气 

分 类 号：R322.3+5[医药卫生—人体解剖和组织胚胎学]