舒适化浅镇静策略护理模式在消化道术后重症患者早期康复锻炼中的应用效果  

The effect of comforted light sedation strategy nursing mode in early rehabilitation exercise for critically ill patients after gastrointestinal surgery

作　　者：柳学梅[1] 陈沭阳 马家渠 Liu Xuemei;Chen Shuyang;MaJiaqu(Shantou Central Hospital Intensive Care Department Zone 2,Shantou 515031,China;Rehabilitation Medicine Department of Shantou Central Hospital,Shantou 515031,China)

机构地区：[1]汕头市中心医院重症医学科二区,汕头515031 [2]汕头市中心医院康复医学科,汕头515031

出　　处：《中国实用护理杂志》2025年第8期608-614,共7页Chinese Journal of Practical Nursing

基　　金：汕头市医疗卫生科技计划(汕府科[2022]81号-73)。

摘　　要：目的探讨舒适化浅镇静策略护理模式在消化道术后重症患者早期康复锻炼中的应用效果,以期为消化道术后患者的康复提供参考。方法2022年7月至2023年12月采用随机对照试验,以目的抽样法,选择汕头市中心医院重症医学科的消化道术后患者110例。应用随机数字法分为对照组和观察组,各55例。对照组采取常规镇静护理,观察组实施舒适化浅镇静策略护理模式。比较2组术后8、24、48、72、96h数字疼痛评分法(NRS)、Richmond躁动-镇静评估量表(RASS)、焦虑自评量表(SAS)评分,镇痛镇静药物用量,术后肠鸣音、排气及排便开始时间,ICU住院时间,谱妄发生率,术后24h英国医学研究委员会(MRC)肌力评分、出院时改良Barthel指数评分量表(MBI)评分。结果研究过程中观察组和对照组分别有5例脱落,各50例完成研究。对照组男32例,女18例,年龄(66.94±14.39)岁;观察组男34例,女16例,年龄(68.01±14.76)岁。术后8、24、48、72、96h观察组的NRS评分分别为(3.11±0.58)、(3.14±0.53)、(3.09±0.56)、(2.97±0.50)、(2.48±0.45)分,均低于对照组的(3.55±0.61)、(3.46±0.59)、(3.42±0.62)、(3.38±0.54)、(2.87±0.53)分,差异均有统计学意义(t值2.80~3.97,均P<0.05)。术后8、24、48、72、96h观察组的RASS评分分别为(-1.42±0.43)、(-1.41±0.42)、(-1.39±0.44)、(-1.36±0.41)、(-1.32±0.40)分,与对照组的(-1.85±0.47)、(-1.78±0.44)、(-1.81±0.50)、(-1.80±0.48)、(-1.68±0.45)分比较,差异均有统计学意义(t值为4.23~4.93,均P<0.05)。术后48、72、96h观察组的SAS评分分别为(49.68±4.55)、(48.69±4.41)、(46.71±4.33)分,与对照组的(53.75±4.76)、(53.13±4.69)、(52.84±4.51)分比较,差异均有统计学意义(t=4.37、4.89、6.93,均P<0.05);观察组丙泊酚用量(3228.52±587.78)mg、右美托咪啶用量(1205.58±311.46)μg,均少于对照组的(4056.77±638.04)mg、(1650.77±432.69)μg,差异均有统计学意义(t=6.75、5.92,均P<0.05),观察组术后肠�Objective To explore the application effect of comfort-based light sedation strategy nursing model in early rehabilitation exercises for critically ill patients after gastrointestinal surgery,aiming to provide a reference for the recovery of patients after gastrointestinal surgery.Methods A randomized controlled trial was conducted using purposive sampling to select 110 critically ill patients who underwent gastrointestinal surgery from July 2022 to December 2023 in the Department of Critical Care Medicine of Shantou Central Hospital.Patients were randomly assigned into the control group and the observation group,with 55 cases in each group.The control group received routine sedation care,while the observation group adopted a comfort-based light sedation strategy nursing model.The NRS(Digital Rating Scale for Pain),RASS(Rationalizing Self-Assessment Scale),SAS(Self-Rating Anxiety Scale),analgesic and sedative drug usage,postoperative bowel sounds,flatus,and defecation onset time,ICU length of stay,delirium incidence,postoperative 24-hour MRC muscle strength score,and discharge Modified Barthel Index(MBI)scores were compared between the two groups at 8 hours,24 hours,48 hours,72 hours,and 96 hours postoperatively.Results During the study,5 cases dropped out from both the observation and control groups,leaving 50 cases each complete.The control group consisted of 32 males and 18 females,with an average age of(66.94±14.39)years;the observation group consisted of 34 males and 16 females,with an average age of(68.01±14.76)years.At 8,24,48,72,96 hours postoperatively,the NRS scores for the observation group were(3.11±0.58),(3.14±0.53),(3.09±0.56),(2.97±0.50),and(2.48±0.45),respectively,were all lower than those of the control group(3.55±0.61),(3.46±0.59),(3.42±0.62),(3.38±0.54),(2.87±0.53),with statistically significant differences(t values were 2.80-3.97,all P<0.05).The RASS scores at postoperative 8,24,48,72,96 hours were(-1.42±0.43),(-1.41±0.42),(-1.39±0.44),(-1.36±0.41),(-1.32±0.40)respectively,com

关 键 词：镇静策略 重症医学科 消化道手术 镇静 镇痛 

分 类 号：R47[医药卫生—护理学]