摘要
目的探讨基于eCASH的舒适镇痛镇静方案对ICU机械通气(MV)患者疗效及氧化应激指标的影响。方法将该院ICU收治的86例实施MV治疗的患者按照随机数字表法分为观察组和对照组,每组43例。对照组采用每日唤醒镇痛镇静方案,重症监护疼痛观察评分(CPOT)维持0~3分,Richmond躁动-镇静评分(RASS)维持在-4^-3分,观察组选择基于eCASH的舒适镇痛镇静方案,CPOT维持在0~1分,RASS维持在-1~0分,使患者达到安静、舒适、合作的镇静状态,并给予人文关怀。比较两组患者MV时间、ICU住院时间、不良反应发生率、镇痛镇静药物用量及氧化应激指标变化情况。结果与对照组比较,观察组MV时间、ICU住院时间明显缩短(P<0.05);两组患者呼吸机相关肺炎及谵妄发生率比较,差异均无统计学意义(P>0.05)。与对照组比较,观察组丙泊酚、右美托咪定、芬太尼用量明显减少(P<0.05)。镇痛镇静后2 d,观察组MDA水平明显下降,SOD、GSH-PX水平明显升高,与对照组比较,差异均有统计学意义(P<0.05)。结论基于eCASH的舒适镇痛镇静方案有助于缩短MV时间,减少镇痛镇静药物用量,同时降低氧化应激反应,改善预后,是ICU内MV患者理想的镇痛镇静方式。
Objective To explore clinical effect of comfort analgesia and sedation based on eCASH model on the efficacy and oxidative stress in ICU patients with mechanical ventilation(MV).Methods A total of 86 patients treated with MV in ICU of Shidong Hospital of Yangpu District were randomly divided into observation group and control group.Patients in control group(n=43)were given daily arousal analgesia and sedation,critical-care pain observation tool(CPOT)maintained 0-3 points,Richmond agitation-sedation score(RASS)maintained-4--3 points.Patients in observation group were given comfort analgesia and sedation based on eCASH model,CPOT maintained 0-1 point,RASS maintained-1-0 point,made the patients reach the state of calm,quiet,comfortable,cooperation and humanistic care.MV time,ICU hospitalization time,incidence of adverse reactions,drug dosage of sedation and analgesics,and indicators of oxidative stress were compared between the two groups.Results Compared with control group,MV time and ICU hospitalization time in observation group shortened significantly(P<0.05).There were no significant differences on the incidence of ventilator associated pneumonia and delirium between the two groups(P>0.05).Compared with control group,the dosage of propofol,dexmedetomidine and fentanyl in observation group reduced significantly(P<0.05).After two days of sedation and analgesia,MDA content decreased significantly,and SOD and GSH-PX levels increased significantly in observation group compared with those of control group(P<0.05).Conclusion Comfort analgesia and sedation based on eCASH model could help shorten MV time,reduce dosage of sedation and analgesia drugs,reduce oxidative stress reaction and improve prognosis,which is an ideal sedation and analgesia method for MV patients in ICU.
作者
叶旭辉
方旭晨
涂春莲
王敏鹏
YE Xuhui;FANG Xuchen;TU Chunlian;WANG Minpeng(Department of Critical Care Medicine,Shidong Hospital of Yangpu District,Shanghai 200438,China)
出处
《检验医学与临床》
CAS
2019年第19期2790-2792,2796,共4页
Laboratory Medicine and Clinic
关键词
舒适化
每日唤醒
镇痛镇静
机械通气
氧化应激
comfort
daily arousal
analgesia and sedation
mechanical ventilation
oxidative stress
