摘要
观察目标化镇痛对ICU机械通气患者预后的影响.共纳入126例机械通气并需要镇痛和镇静的患者,分为经验镇痛组（63例）和重症监护疼痛观察工具（critical-care pain observation tool,CPOT）目标镇痛组（63例）.经验镇痛组根据病情对患者进行常规镇痛和镇静治疗,镇静过程中进行Richmond躁动-镇静量表（RASS）评分,为避免躁动RASS评分〈1分.CPOT目标镇痛组采用CPOT评估患者疼痛,根据CPOT评分调整镇痛药物剂量使CPOT〈2分,如患者躁动则加用镇静药物,使RASS评分〈1分.镇痛药物选用芬太尼,镇静药物选用咪达唑仑、右美托咪定或丙泊酚.同时应用ICU谵妄评估量表（CAM-ICU）评估患者是否合并谵妄.结果显示,CPOT目标镇痛组咪达唑仑用量减少,右美托咪定用量增加,RASS评分由-3分升至-1分,谵妄发生率下降,机械通气时间、住ICU时间缩短.进行CPOT目标化镇痛后患者的镇静深度更浅,谵妄发生率降低,机械通气时间缩短,住ICU时间缩短.
To investigate the impact of goal directed analgesia on the outcome of patients with mechanical ventilation in intensive care unit. A total of 126 patients who needed mechanical ventilation were recruited. With a method of before and after paired comparison, they were divided into two group：（ 1 ） analgesia with empirical administration or control group; （ 2 ） goal directed analgesia based on critical-care pain observation tool （CPOT）. Compared with the control group, after goal directed analgesia was applied, the consumption of midazolam significantly dropped from （ 368. 47 ± 27. 41 ） mg to （ 151. 27 ± 29. 31 ） mg （P〈0. 05）, whereas the consumption of dexmedetomidine significantly increased from （ 623. 62 ± 20. 91） μg to （812. 34 ± 22. 57） μg（P〈0. 05）. The median score of Richmond agitation-sedation scale increased from -3 to -1. The incidence of delirium significantly reduced from 23. 81% to 17. 46%（ P〈0. 05）. The mean ventilator duration was significantly shortened from （168. 49 ± 11. 41） h to （142. 38 ± 13. 24） h（P〈0. 05）. ICU length of stay was significantly shortened from （23. 64 ± 9. 26） d to （19. 63 ± 8. 46） d （ P 〈 0. 05 ） . Due to the mild sedation, patients receiving goal directed analgesia report less delirium, less ventilation time and shorter ICU length of stay, suggesting that the general outcome is improved.
出处
《中华内科杂志》
CAS
CSCD
北大核心
2017年第11期846-848,共3页
Chinese Journal of Internal Medicine
基金
辽宁省教育厅科学研究一般项目（L2014342）
关键词
镇痛
重症监护疼痛观察工具
呼吸
人工
Analgesia
Critical-care pain observation tool
Respiration,artificial
