早期不同镇静水平对ICU机械通气患者临床结局的影响  

Effects of different early sedation levels on clinical outcomes of ICU patients with mechanical ventilation

作　　者：朱红伟 黄德斌[1] 崔妙玲[2] 唐丽安[3] 江淀淀[4] 覃金莲 Zhu Hongwei;Huang Debin;Cui Miaoling;Tang Li′an;Jiang Diandian;Qin Jinlian(Department of Intensive Care Medicine,the Second Ward,the First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China;Department of Nursing,the First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China;Department of Respiratory and Critical Care Medicine,the Second Ward,the First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China;Department of Respiratory and Critical Care Medicine,the First Ward,the First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China)

机构地区：[1]广西医科大学第一附属医院重症医学科二病区,南宁530021 [2]广西医科大学第一附属医院护理部,南宁530021 [3]广西医科大学第一附属医院呼吸与危重症医学科二病区,南宁530021 [4]广西医科大学第一附属医院呼吸与危重症医学科一病区,南宁530021

出　　处：《中国实用护理杂志》2023年第24期1859-1865,共7页Chinese Journal of Practical Nursing

基　　金：广西卫健委自筹经费科研课题(Z20190947)。

摘　　要：目的了解ICU机械通气患者镇静水平状况,探讨早期不同镇静水平对患者临床结局的影响,为更好的指导护士开展镇静评估和实施镇静策略管理提供理论依据。方法本研究为回顾性纵向研究,便利抽样法选取2021年1—12月在广西医科大学第一附属医院重症医学科行镇静治疗的有创机械通气患者201例为研究对象,根据Richmond躁动-镇静评分(RASS)结果将患者分为深镇静组98例,浅镇静组103例;通过Cox多因素分析,探讨患者气管插管留置时间和转归的影响因素。结果在机械通气开始后≤48 h的早期镇静中,RASS为浅镇静的占63.2%(2143/3389),深镇静占35.2%(1194/3389),镇静不足占1.5%(52/3389)。Cox多因素回归分析显示,年龄、镇静水平、有创机械通气时长、连续性肾脏替代治疗是患者气管插留置时间的影响因素(χ^(2)值为4.73~74.31,均P<0.05);早期镇静过深是气管插管拔管延迟的危险因素(HR=0.499,95%CI 0.276~0.903,P<0.05);性别、镇静水平、有创机械通气时长、急性生理学与慢性健康状况评分系统Ⅱ评分、入院方式、连续性肾脏替代治疗是患者转归的影响因素(χ^(2)值为4.41~26.20,均P<0.05);镇静水平越深越不利于患者转归(HR=0.568,95%CI 0.335~0.963,P<0.05)。结论镇静水平与ICU机械通气患者气管插管留置时间和转归相关,不同镇静水平影响患者临床结局。浅镇静患者气管插管留置时间缩短,有利于患者转归。因此,在临床工作中应加强镇静评估,根据患者的需要选镇静方式。在无禁忌的情况下,尽早实施浅镇静策略。本研究为临床镇静策略的制订和管理提供一定的参考和理论依据。Objective To investigate the current sedation level of patients with mechanical ventilation in ICU,and to explore the influence of early different sedation levels on clinical outcomes,so as to provide theoretical basis for better guidance of clinical sedation evaluation and implementation of sedation strategy management.Methods This study was a retrospective longitudinal study.The 201 patients with invasive mechanical ventilation who underwent sedation in the Department of Intensive Care Medicine of the First Affiliated Hospital of Guangxi Medical University from January to December 2021 were selected by convenience sampling method.According to the results of Richmond Agitation-Sedation Scale(RASS),the patients were divided into deep sedation group(98 cases)and shallow sedation group(103 cases).The influencing factors of endotracheal intubation retention time and outcome were investigated by Cox multifactor analysis.Results In the early sedation≤48 h after the start of mechanical ventilation,63.2%(2143/3389)of patients with invasive mechanical ventilation had a RASS score of shallow sedation,35.2%(1194/3389)of patients with deep sedation,and 1.5%(52/3389)of patients with insufficient sedation.Cox multivariate regression analysis showed that age,sedation level,duration of invasive mechanical ventilation and continuous renal replacement therapy were the factors influencing the indentation time of tracheal insertion(χ^(2)values were 4.73 to 74.31,all P<0.05);early deep sedation was a risk factor for delayed extubation(HR=0.499,95%CI 0.276-0.903,P<0.05);gender,sedation level,invasive mechanical ventilation duration,acute physiology and chronic health evaluationⅡscores,admission mode,continuous renal replacement therapywere the influencing factors of patient outcomes(χ^(2)values were 4.41 to 26.20,all P<0.05).The deeper the sedation,the worse the patient outcomes(HR=0.568,95%CI 0.335-0.963 all P<0.05).Conclusions The early sedation level is related to the retention time and outcome of tracheal intubation in ICU

关 键 词：镇静 重症监护病房 机械通气 护理 临床结局 

分 类 号：R473[医药卫生—护理学]