每日唤醒在机械通气镇静患者中的临床应用

Clinical Application of Daily Awaking on Mechanically Ventilated and Sedative Patients

目的探索每日唤醒干预对接受机械通气镇静治疗危重患者的有效性和可行性。方法便利抽样选择2011年8月至2012年12月收治杭州市萧山区第一人民医院重症监护病房(ICU)的177例患者,按照入院时间分为试验组(88例)和对照组(89例),对照组采取镇静药物持续输注,试验组在此基础上实施每日唤醒,比较两组患者镇静药物使用量、机械通气时间、ICU治疗时间、谵妄发生率、护理相关不良事件(如意外拔管、人机对抗、坠床等)及原疾病相关并发症发生率。结果试验组镇静药物用量、机械通气时间、ICU治疗天数明显低于对照组,差异均有统计学意义(均P<0.05),两组丙泊酚用量、谵妄发生率、不良事件及相关并发症发生率比较,差异均无统计学意义(均P>0.05)。结论每日唤醒是预防机械通气危重患者过度镇静的一项安全有效的措施,对患者预后具有积极意义。

Objective To explore the effect and feasibility of daily awaking strategy for severe mechanically ventilated patients with sedation.Methods By convenience sampling,177 patients were selected and admitted to ICU from August 2011 to December 2012 and according to the time coming to hosptial were randomized into experimental group（n=88）and control group（n=89）.Patients in the control group received continuous sedative infusion,while patients in the experimental group were intervened with daily awaking（DA）.The doses of sedatives,durations of mechanical ventilation,ICU stay,incidence of delirium,nursing relevant adverse accidents such as accident extubation,man-machine counteraction,falling out of bed and other complications were compared between the two groups.Results The doses of sedatives,durations of mechanical ventilation and days of ICU stay for the patients in the experimental group were significantly lower than those in the control group（all P〈0.05）.However,there were no differences for the total dose of propofol,nursing accidents,incidence of delirium and relevant complications between the two groups（all P〉0.05）.Conclusion Daily awaking is a safe intervention to reduce over-sedation among severe mechanically ventilated patients,thus plays a positive role to the outcome of these patients.