重症镇痛镇静管理对严重烧伤合并吸入性损伤患者的影响及患者置管时间的影响因素  

Effects of analgesic and sedation management in critical care medicine on patients with severe burns combined with inhalation injuries and the factors affecting tracheal intubation time

作　　者：潘艳艳 范友芬[1] Pan Yanyan;Fan Youfen(Department of Burns,Ningbo No.2 Hospital,Ningbo 315000,China)

机构地区：[1]宁波市第二医院烧伤科,宁波315000

出　　处：《中华烧伤与创面修复杂志》2024年第12期1123-1131,共9页Chinese Journal of Burns And Wounds

基　　金：宁波市医疗卫生高端团队重大攻坚项目(2023030615);宁波市医学重点学科建设项目(2022-F17);浙江省医药卫生科技计划项目(2021KY1004)。

摘　　要：目的分析重症镇痛镇静管理对严重烧伤合并吸入性损伤患者的影响及患者置管时间的影响因素。方法该研究为历史对照研究。宁波市第二医院烧伤科2017年1月—2022年12月收治157例符合入选标准的严重烧伤合并吸入性损伤患者,其中男126例、女31例,年龄14~87岁。收集2017年1月—2019年12月推行重症镇痛镇静管理前(干预前,77例患者)及2020年1月—2022年12月推行重症镇痛镇静管理后(干预后,80例患者)患者的病历资料,包括烧伤总面积、吸入性损伤程度、简明烧伤严重指数(ABSI)评分等一般资料,使用镇痛药物(曲马多、芬太尼、瑞芬太尼)例数、用量、天数及总镇痛例数、天数,使用镇静药物(咪达唑仑、右美托咪定、冬眠合剂)例数、用量、天数及总镇静例数、天数,气管置管天数、住院费用、行机械通气情况(例数、天数)、并发症(继发性肺炎、低血压)发生情况。采用中断时间序列(ITS)分析法和单因素Fine-Gray竞争风险模型分析重症镇痛镇静管理对气管置管时间的影响,并采用单因素和多因素Fine-Gray竞争风险模型筛选气管置管时间的独立影响因素。结果干预前后患者烧伤总面积、吸入性损伤程度、ABSI评分均无明显差异(P>0.05)。干预后患者总镇静天数和总镇痛天数分别为7.0(2.0,14.0)、7.0(4.0,14.0)d,均明显多于干预前的3.0(1.0,5.0)、4.0(3.0,7.0)d(Z值分别为-2.84、-2.91,P<0.05)。与干预前比较,干预后使用咪达唑仑和芬太尼的患者比例均明显升高(χ^(2)值分别为5.68、6.19,P<0.05)、天数均明显增多(Z值分别为-3.67、-2.16,P<0.05),使用曲马多的患者比例明显升高(χ^(2)=6.57,P<0.05),而右美托咪定用量和使用冬眠合剂患者比例均明显降低(Z=-2.17,χ^(2)=14.54,P<0.05)。干预后患者气管置管天数为15.0(9.0,31.0)d,明显多于干预前的12.0(9.0,16.5)d(Z=-2.57,P<0.05)。与干预前比较,干预后患者住院费用明显增加(Z=-2.62,PObjective To analyze the effects of analgesic and sedation management in critical care medicine on patients with severe burns combined with inhalation injuries and the factors affecting the tracheal intubation time.Methods The study was a historical controlled study.A total of 157 patients with severe burns combined with inhalation injuries who met the inclusion criteria were admitted to the Department of Burns of Ningbo No.2 Hospital from January 2017 to December 2022,including 126 males and 31 females,aged 14-87 years.Medical records of patients were collected before adopting the analgesic and sedation management in critical care medicine from January 2017 to December 2019(before intervention,77 patients)and after adopting the analgesic and sedation management in critical care medicine from January 2020 to December 2022(after intervention,80 patients),including the total burn area,degree of inhalation injury,abbreviated burn severity index(ABSI)score,and other general information;the number of patients,dosage,and days of using analgesic drugs(tramadol,fentanyl,and remifentanil),and the total cases and days of analgesia;the number of patients,dosage,days of using sedative drugs(midazolam,dexmedetomidine,and lytic cocktail),and the total cases and days of sedation;the days of tracheal intubation,hospitalization costs,cases and days of mechanical ventilation,and incidence of complications(secondary pneumonia and hypotension).The effects of analgesic and sedation management in critical care medicine on the time of tracheal intubation were analyzed using the interrupted time-series(ITS)analysis and univariate Fine-Gray competing risk model,and the independent factors affecting the time of tracheal intubation were screened using univariate and multivariate Fine-Gray competing risk model.Results There were no significant differences in the total burn area,degree of inhalation injury,and ABSI score between patients before and after intervention(P>0.05).The total sedation days and total analgesia days in patients after

关 键 词：烧伤 镇痛 中断时间序列分析 影响因素分析 吸入性损伤 镇静 

分 类 号：R644[医药卫生—外科学]