模拟人体生物钟镇静用于ICU机械通气患者的临床研究  

Sedation with simulative circadian rhythm in mechanically ventilated intensive care patients

作　　者：王翠婷[1] 董晨明[1] 张虹[1] 宋瑞霞[1] 杨朝辉[1] 冯芳[1] 齐艳[1] 韦宝花 陈宇[1] 杜航[1] 张文杰[1] Wang Cuiting Dong Chenming Zhang Hong Song Ruixia Yang Zhaohui Feng Fang Qi Yan Wei Baohua Chen Yu Du Hang Zhang Wenjie.(First Divi- sion of Intensive Care Unit, The Second Hospital of Lanzhou University, Lanzhou 730030, Chin)

机构地区：[1]兰州大学第二医院重症医学一科,甘肃兰州730030

出　　处：《护理学杂志》2017年第2期19-23,共5页Journal of Nursing Science

基　　金：甘肃省卫生行业科研计划项目(GSWSKY-2014-32)

摘　　要：目的探讨模拟人体生物钟镇静方案对ICU机械通气患者谵妄及其他临床结局的影响。方法将110例ICU有创机械通气≥12h患者根据是否应用模拟人体生物钟镇静方案分为模拟人体生物钟组(研究组,55例)与非模拟人体生物钟组(对照组,55例),两组再根据使用镇静药物的不同分为右美托咪定组(各15例)、丙泊酚组(各20例)、右美托咪定+丙泊酚组(联合镇静组,各20例)。应用重症监护疼痛观察工具(CPOT)及Richmond躁动-镇静评分(RASS)对镇痛镇静深度进行量化控制,使研究组RASS评分白天维持在0~1分、夜间维持在-1^-2分;对照组昼夜均维持在-1^-2分。记录患者谵妄、呼吸机相关性肺炎等并发症或不良事件发生率,以及机械通气时间、住ICU时间、拔管时间、镇痛镇静药物用量。结果研究组谵妄、呼吸机相关性肺炎、严重低血压及心动过缓发生率显著低于对照组(P<0.05,P<0.01);与同种镇静药的对照组比较,研究组机械通气时间、拔管时间、住ICU时间显著缩短,镇痛镇静药物剂量显著减少(均P<0.05)。结论模拟人体生物钟镇静有助于降低ICU机械通气患者不良反应发生率,缩短机械通气时间、拔管时间及住ICU时间,减少镇静镇痛药物用量,可提高临床疗效。Objective To explore the effects of sedation with simulative circadian rhythm on delirium and the other clinical outcomes in me- chanically ventilated intensive care patients. Methods A total of 110 patients with duration of mechanical ventilation^12 h were randomized into two groups of control and intervention, with 55 in each group. Then subjects in both groups received dexmedetomidine （n= 15）, propofol （n=20）, and dexmedetomidine combined with propofol （n= 20） for sedation respectively. Sedatives were titrated according to the Critical Care Pain Observation Tool （CPOT） and Richmond Agitation Sedation Scale （RASS） to maintain the sedation level of patients, with the target RASS score of 0 to 1 during day and -2 to -1 during night （22：00 to 7.00） in the intervention group, and of -2 to -1 during day and night in the control group. The incidence of complications or adverse reactions such as delirium and ventilator-associated pneumonia （VAP）, duration of mechanical ventilation, length of ICU stay, extubation time and dosage of sedatives were recorded. Results The incidence rates of delirium, VAP, severe hypotension and bradyeardia were significantly lower in the intervention group than the con- trol group （P〈0.05, P〈0.01）. Duration of mechanical ventilation, extubation time, and length of ICU stay were significantly shorter in the intervention group when compared with the control group using the same sedative, and the dosage of sedatives was significantly less in the intervention group （P〈0.05 for aiD. Conclusion Sedation with simulative circadian rhythm is beneficial for ICU ventilated patients to decrease adverse reactions, shorten duration of mechanical ventilation and extubation time as well as ICU stay, reduce use of sedatives, thus to promote clinical efficacy.

关 键 词：危重症患者 ICU 机械通气 模拟人体生物钟 谵妄 右美托咪定 丙泊酚 镇静 

分 类 号：R471[医药卫生—护理学]