目标导向性镇痛在无创正压通气中的应用  

Application of goal directed analgesia in noninvasive positive pressure ventilation

作　　者：窦志敏[1] 李芬娇 陈启明[1] 李斌[1] 刘健[1] DOU Zhimin;LI Fenjiao;CHEN Qiming;LI Bin;LIU Jian(Department of Critical Care Medicine,The First Hospital of Lanzhou University,Lanzhou,Gansu 730000,P.R.China.)

机构地区：[1]兰州大学第一医院重症医学科,甘肃兰州730000

出　　处：《中国呼吸与危重监护杂志》2019年第5期457-460,共4页Chinese Journal of Respiratory and Critical Care Medicine

基　　金：甘肃省自然科学基金项目(1308RJZA240)

摘　　要：目的探讨目标导向性镇痛对重症加强治疗病房(ICU)无创正压通气(NPPV)患者的影响。方法回顾性分析。纳入我院ICU收治的需NPPV的264例患者,其中经验性镇痛组118例,目标性镇痛组146例。经验性镇痛组常规给予镇痛镇静治疗,镇痛药物采用瑞芬太尼,镇静药物采用丙泊酚、咪达唑仑或右美托咪定,镇静深度维持Richmond躁动-镇静量表(RASS)评分<1分;目标性镇痛组先用瑞芬太尼使重症监护疼痛观察工具评分<2分,镇痛达标后再用镇静药物使RASS评分维持在<1分。所有患者均利用ICU谵妄评估量表评估是否发生谵妄。分别观察两组患者NPPV停止时镇痛和镇静药物的用量、依从性(以开始通气后24 h内的总通气时间为依据)、谵妄发生率、有创通气率、NPPV总时间和ICU住院时间。结果两组患者的年龄、性别、APACHEⅡ评分,通气前的平均动脉压、心率、呼吸频率、SpO2、动脉血气值、NPPV原因比较,差异均无统计学意义。目标性镇痛组镇痛、镇静药物剂量均少于经验性镇痛组,其依从性高于经验性镇痛组[(12.6±5.8)h比(10.9±4.8)h],P<0.05),而谵妄发生率和有创通气率均低于经验性镇痛组(分别为15.8%比25.4%和32.9%比44.9%,均P<0.05)。目标性镇痛组NPPV总时间较经验性镇痛组缩短[(28.6±8.8)h比(37.3±10.7)h,P<0.05],但两组患者ICU住院时间比较,差异无统计学意义。结论目标导向性镇痛可改善NPPV患者的依存性,减少镇静药物的使用,降低其谵妄发生率和有创通气率。Objective To explore the effect of goal directed analgesia on patients with noninvasive positive pressure ventilation(NPPV)in the intensive care unit(ICU).Methods This was a retrospective study.Two hundred sixty-four patients requiring non-invasive positive pressure ventilation were enrolled in the ICU of this hospital,including118 patients in the empirical analgesia group and 146 in the goal directed analgesia group.The empirical analgesia group was treated with remifentanil to analgesia and propofol,midazolam or dexmedetomidine to sedation.The sedative depth maintained<1 measured by the score of the Richmond restless sedative scale(RASS).The same analgesic and sedative drug were first used in the goal directed analgesia group to maintain the Critical Care Pain Observation Tool score<2,and the RASS score<1 was maintained after the analgesia depth were achieved.Whether the patients occurred delirium was assessed by the Confusion Assessment Method for the ICU.The dosage of analgesic and sedative drugs,the dependability(based on the total ventilation time in the first 24 hours after ventilation),the incidence of delirium,the rate of invasive ventilation,the total time of NPPV and the length of stay of ICU were observed in the two groups.Results There were no significant differences in age,sex,APACHEⅡscore,mean arterial pressure,heart rate,respiratory rate,SpO2,arterial blood gas and the reason of NPPV between the two groups.The dosage of analgesic and sedative drugs in the goal directed analgesia group were less than the empirical analgesia group,and the dependability was higher than that of the empirical analgesia group[(12.6±5.8)h vs.(10.9±4.8)h,P<0.05),and the incidence of delirium and the rate of invasive ventilation were also lower than those of the empirical analgesia group(15.8%vs.25.4%,P<0.05;32.9%vs.44.9%,P<0.05).The total time of NPPV in the goal directed analgesia group was shorter than that of the empirical analgesia group[(28.6±8.8)h vs.Objective To explore the effect of goal directed analgesia on

关 键 词：镇痛 无创正压通气 重症监护疼痛观察工具 

分 类 号：R459.7[医药卫生—急诊医学]