镇静剂在急诊危重病救治中的应用调查

Application Investigation of Sedatives in the Emergency Treatment of Critical Care

目的 探讨镇静剂在急诊重症加强治疗病房（emergency intensive care unit,EICU）危重病救治过程中的应用,进一步提高急危重患者镇静应用的合理性.方法 回顾笔者医院2007年8月～2011年7月期间入住EICU应用镇静剂患者的临床资料,对疾病分布情况、应用镇静剂的种类、用药时间及镇静过度病人的肝、肾及循环功能进行统计学分析.结果 该阶段入住笔者医院EICU的患者总数1198人,其中应用镇静剂的184人,占15.36％.在镇静治疗的同时接受机械通气的患者占82.61％.镇静剂应用患者疾病分布中肺部疾病占20.11％（P=0.00）,其中重症肺炎占8.7％（P=0.02）.常用的镇静剂有咪达唑仑占41.3％,安定占54.89％,丙泊酚占60.87％.镇静剂单药应用的占50％,短期用药（≤24h）的占52.17％.有16例患者出现镇静过度表现.单因素分析显示年龄＞ 60岁、丙氨酸氨基转移酶＞55U/L、天冬氨酸氨基转移酶＞60U/L、肌酐＞133μmol/L、尿素氮＞ 7.1 mmol/L、休克是导致镇静过度的危险因素.多因素logistic回归分析显示尿素氮＞7.1 mmol/L、休克是导致镇静过度的独立危险因素.结论 镇静主要用于需要机械通气的急诊危重患者,且多为短期应用.根据患者生命体征、镇静等级和血流动力学状态逐渐调整给药剂量,是防止镇静过度的主要措施.

Objective To Summary the application experiences of sedatives in EICU,and to improve the application of reasonable Intensive sedation.Methods Medical records of patients treated in EICU from August 2007 through July 2011 were reviewed retrospectively,and statistical analysis was performed to determine the distribution of disease,types of sedatives,administration time,renal,liver and circular function of patients who receive over-sedation.Results Among 1198 cases treated in EICU,patients who receive sedation was present in 15.36％ （184/1198）,82.61％ of which receive mechanical ventilation at the same time.Among the sedation distribution of disease,lung disease was present in 20.11％ （P =0.00）,including severe pneumonia accounted for 8.7 ％ （P =0.02）.The three commonly used sedative drugs was propofol （accounted for 60.87％）,diazepam （accounted for 54.89％）,midazolam （accounted for 41.3％）.One-drug sedation accounted for 50％.Short-time sedation（＜ 24h） accounted for 52.17％.There were 16 patients who receive excessive sedation.One way ANOVA showed that age ＞ 60years,ALT ＞ 55 U/L,AST ＞ 60U/L,Cr ＞ 133μmol/L,BUN ＞ 7.1 mmol/L,and shock could cause excessive sedation.The multivariable logistic regression showed that Bun ＞ 7.1 mmol/L,shock were independent factors of excessive sedation.Conclusion Sedation is mainly used for requiring mechanical ventilation in emergency critically patients,and mostly short-term application.Based on the patients＇vital signs,sedation grade and hemodynamic state gradually adjusting the dose,that is the main measure to prevent excessive sedation.