摘要
目的探讨程序化镇静镇痛(PSA)控制小组应用于重型颅脑损伤患者术后的效果。方法选择2018年12月至2020年12月该院收治的重型颅脑损伤患者110例,随机分为2组,每组各55例。对照组行持续性镇静镇痛干预,采用芬太尼0.03~0.06 mg/h及右美托咪定0.01~0.04 mg/h持续泵入,根据临床检验停药;观察组行PSA控制小组干预,确定镇痛镇静目标(Ramsay评分为3~4分,NRS<6分),每3小时进行镇静、镇痛效果评估,再调整药物剂量,晨间唤醒。比较2组患者术后第3天不同时间点镇静效果、镇痛效果、颅内压水平,比较2组术后镇静镇痛药物使用剂量、ICU入住时间、总住院时间及谵妄发生率。结果观察组术后第3天0:00、4:00的Ramsay评分高于对照组NRS低于对照组(P<0.001),但观察组术后第3天8:00、12:00、16:00、20:00的Ramsay评分、NRS评分与对照组比较,差异无统计学意义(P>0.05);观察组术后第3天各个时间点颅内压水平均低于对照组(P<0.05);观察组术后第3天芬太尼及右美托咪定的总使用剂量、平均使用剂量均少于对照组(P<0.05);观察组ICU入住时间、总住院时间均短于对照组(P<0.05);观察组谵妄发生率低于对照组(P<0.05)。结论PSA控制小组应用于重型颅脑损伤术后患者可有效镇静镇痛,降低颅内压水平,减少镇静镇痛药物使用剂量,缩短住院时间,降低谵妄发生率。
Objective To explore the effect of programmed sedation and analgesia(PSA)control group in patients with severe head injury after surgery.Methods A total of 110 patients with severe craniocerebral injury admitted to this hospital from December 2018 to December 2020 were selected and randomly divided into 2 groups,with 55 cases in each group.The control group received continuous sedation and analgesia intervention,with fentanyl 0.03-0.06 mg/h and dexmedetomidine 0.01-0.04 mg/h continuous pumping,and the drug was discontinued according to the clinical testing;The observation group received PSA control group intervention,determined the goal of analgesia and sedation(Ramsay score was 3-4 points,NRS score was less than 6 points),evaluated the effects of sedation and analgesia every 3 h,adjusted the drug dose,and woke up in the morning.The sedation,analgesic effect,intracranial pressure level between the two groups at different time points on the 3rd day after surgery,dosage of sedative and analgesic drugs,length of stay in ICU,total length of hospital stay,and incidence of delirium were compared between the two group after surgery.Results The Ramsay score and NRS score of the observation group at 0:00 and 4:00 on the 3rd day after operation were higher than those of the control group(P<0.05);The Ramsay score and NRS score in the observation group at 8:00,12:00,16:00 and 20:00 on the 3rd day after operation were not statistically different when compared with the control ggroup(P>0.05).The intracranial pressure level of the observation group were lower than that of the control group on the 3rd day after operation(P<0.05).The total and average dosesof fentanyl and dexmedetomidine in the observation group were less than those in the control group on the 3rd day after operative(P<0.05).The length of stay in ICU and the total length of hospital stay in the observation group were shorter than those in the control group(P<0.05).The incidence of delirium in the observation group was lower than that in the control group(P<0.05).
作者
吕晨
张艳
钱小丽
管义祥
LYU Chen;ZHANG Yan;QIAN Xiaoli;GUAN Yixiang(Department of Critical Care Medicine,Hai′an Hospital Affiliated to Nantong University,Hai′an,Jiangsu 226600,China)
出处
《重庆医学》
CAS
2022年第8期1326-1329,1334,共5页
Chongqing medicine
基金
江苏省“333”工程科研资助项目(BRA2016187)
南通大学临床医学专项项目(2019HY008)。
关键词
镇静镇痛控制小组
颅脑损伤
重型
镇静
镇痛
颅内压
谵妄
PSA control group
head injury
severe
sedation
analgesia
intracranial pressure
delirium
