每日唤醒对机械通气镇痛镇静患者谵妄干预作用的研究  

The research of the role of daily awaking on delirium intervention in mechanically ventilated patients with analgesia and sedation

作　　者：郑盼盼[1] 章敏[1] 田小玲[1] 金王燕[1] 

机构地区：[1]浙江省杭州市萧山区第一人民医院重症医学科,浙江杭州311200

出　　处：《护士进修杂志》2016年第2期102-106,共5页Journal of Nurses Training

基　　金：浙江省杭州市科技计划项目(编号:2011B051)

摘　　要：目的探索每日唤醒方法对接受机械通气和镇痛、镇静治疗的危重患者在谵妄干预中的作用。方法选择2013年5月-2014年8月收治杭州市萧山区第一人民医院重症监护病房(ICU)的252例患者,随机分为观察组和对照组,对照组采取镇痛、镇静药物持续输注;观察组实施每日唤醒。两组患者的镇痛、镇静药物应用均遵循剂量最小化原则,即在保证患者舒适、安全的前提下,尽可能减少药物使用量,并在观察组患者唤醒期间对两组患者同时进行自发呼吸试验,比较两组患者谵妄的发生率、镇痛、镇静药物使用量、机械通气时间、镇静时间及ICU治疗时间、护理相关不良事件(如意外拔管、人机对抗、坠床等)及与原疾病相关并发症的发生率。结果观察组患者谵妄的发生率低于对照组(P<0.05),且观察组镇静药物用量、机械通气时间、镇静时间及ICU治疗时间明显低于对照组,差异有统计学意义(P<0.05),而两组镇痛药物用量、不良事件及并发症发生率比较差异无统计学意义(P>0.05)。结论作为预防过度镇静的方法,每日唤醒可减少机械通气患者镇静药物用量,减少机械通气时间、镇静时间及ICU治疗天数,对预防谵妄的发生具有积极作用。Objective To explore the effect of daily awaking strategy for delirium intervention in severe mechanically ventilated patients with analgesia and sedation. Methods By convenience sampling,252 patients admitted to ICU from May 2013 to August 2014 and qualified for the experiment, were randomized into 2 groups. Patients in the control group received continuous sedative infusion, while patients in the experimental group were intervened with daily awaking （DA）. Drug delivery for both of the two groups follows dose minimization principle,i, e. ,on the premise of ensuring safety and comfort of patients, reduce the drug use as far as possible. Spontaneous breathing trials were treated for both groups during DA times for the experimental group. The incidences of delirium,doses of analgesia and sedatives,durations of mechanical ventilation, sedative days, length of ICU stay, nursing relevant adverse accidents such as self-extubation,man-machine counteraction,falling out of bed and other complications were compared between the two groups. Results Incidences of delirium , doses of sedatives,durations of mechanical ventilation, days of sedation and length of ICU stay for the patients in the experimental group were significantly lower than those in the control group. However, there were no differences for the dose of morphine, nursing accidents and complications between the two groups. Conclusion Daily awaking is a safe intervene to reduce over-sedation among severe mechanically ventilated patients,thus plays a positive role to the prevention of delirium in these patients.

关 键 词：谵妄 每日唤醒 机械通气 镇痛 镇静 

分 类 号：R595.4[医药卫生—内科学]