目标化镇痛对ICU机械通气患者预后的影响  

The impact of goal directed analgesia on mechanical ventilated patients′s outcomes in intensive care unit：a clinical observational study

作　　者：李青栋[1] 万献尧[1] 张永利[1] 李素玮[1] 韩丽丽[1] 李文雯[1] 史华英[1] 

机构地区：[1]医科大学附属第一医院重症医学科,大连医科大学重症医学研究所,大连116011

出　　处：《中华内科杂志》2017年第11期846-848,共3页Chinese Journal of Internal Medicine

基　　金：辽宁省教育厅科学研究一般项目（L2014342）

摘　　要：观察目标化镇痛对ICU机械通气患者预后的影响.共纳入126例机械通气并需要镇痛和镇静的患者,分为经验镇痛组（63例）和重症监护疼痛观察工具（critical-care pain observation tool,CPOT）目标镇痛组（63例）.经验镇痛组根据病情对患者进行常规镇痛和镇静治疗,镇静过程中进行Richmond躁动-镇静量表（RASS）评分,为避免躁动RASS评分〈1分.CPOT目标镇痛组采用CPOT评估患者疼痛,根据CPOT评分调整镇痛药物剂量使CPOT〈2分,如患者躁动则加用镇静药物,使RASS评分〈1分.镇痛药物选用芬太尼,镇静药物选用咪达唑仑、右美托咪定或丙泊酚.同时应用ICU谵妄评估量表（CAM-ICU）评估患者是否合并谵妄.结果显示,CPOT目标镇痛组咪达唑仑用量减少,右美托咪定用量增加,RASS评分由-3分升至-1分,谵妄发生率下降,机械通气时间、住ICU时间缩短.进行CPOT目标化镇痛后患者的镇静深度更浅,谵妄发生率降低,机械通气时间缩短,住ICU时间缩短.To investigate the impact of goal directed analgesia on the outcome of patients with mechanical ventilation in intensive care unit. A total of 126 patients who needed mechanical ventilation were recruited. With a method of before and after paired comparison, they were divided into two group：（ 1 ） analgesia with empirical administration or control group; （ 2 ） goal directed analgesia based on critical-care pain observation tool （CPOT）. Compared with the control group, after goal directed analgesia was applied, the consumption of midazolam significantly dropped from （ 368. 47 ± 27. 41 ） mg to （ 151. 27 ± 29. 31 ） mg （P〈0. 05）, whereas the consumption of dexmedetomidine significantly increased from （ 623. 62 ± 20. 91） μg to （812. 34 ± 22. 57） μg（P〈0. 05）. The median score of Richmond agitation-sedation scale increased from -3 to -1. The incidence of delirium significantly reduced from 23. 81% to 17. 46%（ P〈0. 05）. The mean ventilator duration was significantly shortened from （168. 49 ± 11. 41） h to （142. 38 ± 13. 24） h（P〈0. 05）. ICU length of stay was significantly shortened from （23. 64 ± 9. 26） d to （19. 63 ± 8. 46） d （ P 〈 0. 05 ） . Due to the mild sedation, patients receiving goal directed analgesia report less delirium, less ventilation time and shorter ICU length of stay, suggesting that the general outcome is improved.

关 键 词：镇痛 重症监护疼痛观察工具 呼吸 人工 

分 类 号：R459.7[医药卫生—急诊医学]