镇静-镇痛策略与机械通气患者ICU不适经历关系的多中心调查研究  

A nationwide multi-center survey on the relationship between ICU uncomfortable experiences and sedation-analgesic strategy in mechanically ventilated patients

作　　者：马朋林[1] 李秦[1] 刘京涛[1] 苏瑾文[1] 王宇[1] 

机构地区：[1]解放军总医院第二附属医院急救部,北京100091

出　　处：《解放军医学杂志》2008年第8期957-959,共3页Medical Journal of Chinese People's Liberation Army

基　　金：中国病理生理学会危重病专业委员会与欧洲危重病学会合作项目(Health-2007-3.1-3)

摘　　要：目的了解我国ICU机械通气患者镇静、镇痛治疗的现状,以进一步探讨镇静-镇痛策略对该类患者ICU不适住院经历的影响。方法2006年6月15日-2006年8月15日,对全国31家三级甲等教学医院所有转出ICU的清醒机械通气患者进行调查,内容包括患者一般情况,疾病分类,机械通气时间,所接受的镇静-镇痛治疗,以及包括紧张害怕、情绪低落、睡眠不良、疲劳感、口渴、疼痛等6项内容的ICU不适经历情况。结果163例接受机械通气的ICU清醒患者中,出现ICU不适经历的比例高达96.9%,其中83例(50.9%)出现严重不适。机械通气时间≥48h的患者严重不适经历发生率为59.7%,与机械通气时间<48h的患者(44.8%)比较无统计学差异。61例未给予任何镇静、镇痛治疗,其严重不适经历发生率(73.8%)显著高于接受镇静、镇痛治疗的患者(37.3%,P<0.01)。以镇痛为基础的镇静治疗方案对严重不适经历的发生具有显著的保护作用(OR=0.125;95%CI:0.052～0.298;P<0.01),单独应用镇静剂或镇痛药保护作用差。结论恰当的镇静-镇痛治疗可有效降低ICU严重不适经历的发生率。我国ICU机械通气患者接受系统镇静-镇痛治疗的比例较低,对ICU医师进行系统镇静-镇痛知识和方法的培训亟待加强。Objective To investigate the status of mechanically ventilated patients undergone sedation analgesic therapy in ICU,and explore the influence of sedation-analgesic strategy on ICU uncomfortable experiences of mechanically ventilated patients by a nationwide multi-center survey in China.Methods From Jun.15th to Aug.15th,2006,conscious patients,who received mechanical ventilation（MV）and had been transferred to general ward,were consecutively selected from 31 ICUs of academic hospitals nationwide.Survey was done including general information of patients,category of diseases,hours of MV,sedation analgesic therapy and a personal interview about the following ICU uncomfortable events：fear,depression,sleepless,fatigue,thirsty and pain.Results The incidence of ICU uncomfortable events was as high as 96.9% in the recruited 163 cases.83 of 163 patients（50.9%）experienced severe uncomfortable events（SUE）.Patients received MV longer than 48 hours showed a slight higher incidence of SUE,with no statistical significance,compared with those patients received MV less than 48 hours（59.7% vs 44.8%,P〉0.05）.61 patients received no sedatives nor analgesics showed significantly higher incidence of SUE compared with those patients received either sedatives or analgesics（73.8% vs 37.3%,P〈0.01）.Systemic sedation based on analgesics could effectively protect patients from SUE（OR：0.125;95%CI：0.052-0.298;P〈0.01）,while no sedatives nor analgesics could do alone.Conclusion Optimal sedation-analgesic therapy may effectively reduce the incidence of SUE in ICU conscious patients with MV.However,only a few MV patients in Chinese ICUs have received systemic sedation-analgesic therapy.It is urgent to emphasize the training about the knowledge of sedation-analgesic therapy in Chinese intensive physicians.

关 键 词：清醒镇静 镇痛 不适经历 呼吸 人工 重症监护 

分 类 号：R459.7[医药卫生—急诊医学]