早期目标导向镇静在ICU无创机械通气患者中的应用研究  

The Application Research of Early Goal-Directed Sedation Used in ICU Patients With Non-invasive Mechanical Ventilation

作　　者：金涛[1] 辛绍斌[2] 苏毅[2] 

机构地区：[1]天津市南开医院重症医学科,天津300100 [2]天津市人民医院重症医学科,天津300121

出　　处：《继续医学教育》2016年第10期139-141,共3页Continuing Medical Education

摘　　要：目的 探讨在ICU无创机械通气患者中实施早期目标导向镇静（EGDS）的临床意义。方法 选取天津市人民医院2015年3月-2016年6月入住ICU接受无创机械通气的104例患者为研究对象,经患者或家属同意纳入研究。以右美托咪定或丙泊酚为主导镇静药物实施EGDS。将入组患者随机分为试验A组（右美托咪定组）和试验B组（丙泊酚组）及无EGDS的对照组。比较各组患者镇静达标时间;不良事件（如心动过缓、血压降低、低氧血症等）发生率;无创机械通气治疗有效率和不耐受率,以及ICU留住时间等。结果 A组与对照组相比：两组间不良事件发生率差异无统计学意义（P〉0.05）;A组无创机械通气治疗有效率和不耐受率以及留住ICU时间低于对照组,差异有统计学意义（P〈0.05）。B组与对照组相比：B组不良事件发生率高于对照组,差异有统计学意义（P〈0.05）;B组无创机械通气治疗有效率和不耐受率以及留住ICU时间均低于对照组,差异有统计学意义（P〈0.05）。A组与B组相比：A组镇静达标时间更短,差异有统计学意义（P〈0.05）;A组不良事件发生率和无创机械通气不耐受率低于B组,差异有统计学意义（P〈0.05）;两组间无创机械通气治疗有效率以及留住ICU时间差异无统计学意义（P〉0.05）。结论 以右美托咪定为主导的EGDS在ICU无创机械通气治疗患者中安全可行。EGDS可以提高重症患者无创机械通气治疗的耐受性,从而改善治疗效果,并缩短ICU的留住时间。Objective To assess the cl inical significance of early goaldirected sedation in ICU patients with non-invasive mechanical ventilation. Methods Selected the 104 patients into the study with the approval of the patients or their family members, who accepted non-invasive mechanical ventilation in ICU from March 2015 to June 2016. Using dexmedetomidine or propofol as the leading to implement the early goal-directed sedation. The selected cases were randomly divided into three groups, two experimental groups were carried out the EGDS and one control group without the EGDS. To compare the time requirds of sedation, the incidence of adverse events such as bradycardia, hypotension, hyoxemia and so on, the efficient and intolerant rate of non-invasive mechanical ventilation; the time of stay in the ICU, and so on. Results The group A compared with the control group： There was no statistically significant difference between the two groups about the incidence of adverse events（P〈0.05）. The efficient and intolerant rate of non-invasive mechanical ventilation and the time of stay in the ICU in the group A were lower than the control group, differences were statistically significant（P〈0.05）. The group B compared with the control group： The incidence of adverse events in group B was higher than the control group, difference was statistically significant（P〉0.05）. The efficient and intolerant rate of non-invasive mechanical ventilation and the time of stay in the ICU in the group B were lower than the control group, differences were statistically significant（P〈0.05）. The group A compared with the group B： The time requirds of sedation in group A was shorter than the group B, difference was statistically significant（P〈0.05）. The incidence of adverse events and the intolerant rate of noninvasive mechanical ventilation in the group A were significantly lower than the group B, differences were statistically significant（P〈0.05）. There were no statistically significant differences between the

关 键 词：早期目标导向镇静 重症监护病房 无创机械通气 

分 类 号：R605[医药卫生—外科学]