不同镇静方案对神经重症患者循环稳定性的影响——一项单中心回顾性研究  

Effects on circulatory stability of different sedation regimens in neurological intensive care unit patients:a single-center retrospective study

作　　者：梁勇 郇宇 白杨 熊剑 Liang Yong;Huan Yu;Bai Yang;Xiong Jian(Department of Neurosurgery Care Unit,General Hospital of Northern Theater Command,Shenyang 110016,Liaoning,China)

机构地区：[1]北部战区总医院神经外科监护病房,辽宁沈阳110016

出　　处：《中国中西医结合急救杂志》2023年第4期476-479,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：国家自然科学基金(82101318)。

摘　　要：目的探讨不同镇静方案对神经重症监护病房(NICU)患者长期深镇静时循环稳定性及近远期预后的影响。方法回顾性分析2021年12月至2022年9月北部战区总医院NICU收住的接受长期深镇静治疗的机械通气患者的临床资料,镇静时间(72±24)h,镇静目标Richmond躁动-镇静评分(RASS)为-2~-4分,通过医院信息系统(HIS)或护理记录单收集患者诊疗信息,根据镇静治疗方案不同将患者分为单药镇静组和联用镇静组。比较暴露于不同镇静方案下NICU机械通气患者循环系统相关不良事件发生情况、持续时间、血管活性药物使用情况及近远期结局。结果共纳入123例患者,其中113例纳入回顾性数据分析,其中单药镇静组(48例)和联用镇静组(65例)。单药镇静时,环泊酚组低血压发生患者数与丙泊酚组相当(例:8比5),低血压持续时间较丙泊酚组显著缩短(h:33.57±14.25比63.25±21.53,P<0.05)。联用镇静组低血压发生患者数较单药镇静组更多(例:35比19),丙泊酚+右美托咪定组和咪达唑仑+右美托咪定组镇静时低血压发生患者数较多(分别为13例和6例)。与其他镇静方案相比,含右美托咪定的镇静方案发生心动过缓的患者数较多。结论对于NICU机械通气患者,单用环泊酚组低血压持续时间较丙泊酚组明显缩短,与单用镇静方案相比,联用镇静方案对循环稳定性影响更大,不同镇静方案与预后的相关性仍需进一步探索。Objective To investigate the effects of different sedation regimens on circulation stability and short-term and long-term prognosis of patients in neurosurgery intensive care unit(NICU)during long-term and deep sedation.Methods Retrospective analysis was performed on mechanical ventilation patients admitted to department of NICU in the General Hospital of Northern Theater Command from December 2021 to September 2022 who received long-term and deep sedation.The sedation duration was(72±24)hours,and the sedation target was Richmond agitationsedation scale(RASS)-2 to-4.Patient information was collected through hospital information system(HIS)system or nursing record sheet.According to the different sedation treatment plan,patients were divided into single drug sedation group and combined sedation group.The occurrence and duration of circulatory system related adverse events,usage of vasoactive drugs and outcomes of NICU patients with mechanical ventilation exposed to different sedation regiments were compared.Results A total of 123 patients were included,113 of whom were included in retrospective data analysis,including the single sedation group(48 cases)and the combined sedation group(65 cases).In single sedation group,the number of patients of hypotension in ciprofol group was similar to that in propofol group(cases:8 vs.5),but the duration was significantly shortened(hours:33.57±14.25 vs.63.25±21.53,P<0.05).The number of patients of hypotension was more in the combined sedation group than in the single drug sedation group(cases:35 vs.19).The number of patients of hypotension in the group of propofol or midazolam combined with dexmedetomidine were 13 cases and 6 cases,respectively.Sedation regimens containing dexmedetomidine had more patients of bradycardia than other sedation regimens.Conclusions For NICU patients with mechanical ventilation,the duration of hypotension of ciprofol was significantly shorter than that of propofol.Compared with single drug sedation group,combined sedation group has a greater effe

关 键 词：神经重症监护病房 机械通气 镇静治疗 环泊酚 循环稳定性 

分 类 号：R459.7[医药卫生—急诊医学]