镇静方案不同控制目标在机械通气患者长途院间转诊中的运用研究

Different Target Sedation Scores for Mechanical Ventilation Patients in Long-distance Inter-hospital Transport

目的探讨镇静方案不同控制目标在机械通气患者长途院间转诊中的运用效果。方法选取2015年5月—2016年5月需长途转诊至重庆医科大学附属第一医院的患者117例,按照转诊日期进行分组,奇数日转诊者为对照组(60例),偶数日转诊者为观察组(57例)。患者均接受有创机械通气,转诊过程中使用芬太尼和丙泊酚联合镇静方案,对照组控制目标为Riker镇静、躁动评分(SAS)4分,观察组控制目标为SAS 2分,比较两组不同时间心率、呼吸、平均动脉压(MAP)、血氧饱和度(SpO_2)和不良事件(气管移位、导管滑脱、坠床、呕吐、压力性损伤)的发生情况。结果 用药前及开始转诊后0、30、150 min两组心率比较,差异均无统计学意义(P>0.05);开始转诊后60、90、120 min观察组心率较对照组减慢(P<0.05)。用药前两组呼吸比较,差异无统计学意义(P>0.05);开始转诊后0、30、60、90、120、150 min观察组呼吸较对照组减慢(P<0.05)。用药前及开始转诊后0、30、120、150min两组MAP比较,差异均无统计学意义(P>0.05);开始转诊后60 min观察组MAP较对照组升高,开始转诊后90min观察组MAP较对照组降低(P<0.05)。用药前及开始转诊后0、30、60、90、120、150 min两组SpO_2比较,差异均无统计学意义(P>0.05)。观察组气管移位、导管滑脱、坠床及总不良事件发生率较对照组降低(P<0.05);两组呕吐和压力性损伤发生率比较,差异均无统计学意义(P>0.05)。结论 使用有创机械通气的患者转诊时控制目标为SAS 2分的镇静方案既保证血流动力学的稳定,又有效地控制了不良事件的发生。

Objective To investigate the effect of different target sedation scores on mechanical ventilation patients in long - distance inter - hospital transport. Methods The participants enrolled in this study were 117 invasive mechanical ventilation patients who needed to be transferred to the First Affiliated Hospital of Chongqing Medical University from far away from May 2015 to May 2016. In accordance with the parity of the transfer date , they were divided into the control group （60 transferred on odd days） , and the observation group （57 transferred on even days） . During the transport , both groups received intravenous infusion of fentanyl and propofol for conscious sedation. The controlled target of sedation score assesseSedation - Agitation Scale （SAS） was 4 points for the control group , and 2 points for the observation group. The heart rate （HR） , respiratory rate （ RR） , mean arterial pressure （ MAP） , peripheral oxygen saturation （ SpO2 ） measured at different time points and incidence of adverse events （ airway shift , catheter slippage , falling off the bed , vomiting , stress injury） duringthe transport were compared between the groups. Results The HR measured before the administration at the time of starting transferring , 30 , and 150 min after the starting of transferring did not differ significantly between the groups（P 〉0. 05） ; while the HR measured at 60, 90,and 120 min after the starting of transferring in the observation group wasdecreased than that in the control group, respectively （ P 〈 0.05 ）. Two groups had no obvious difference in the RR measured before the administration of propofol and fentanyl （ P 〉 0. 05 ）,but it was found that the RR was decreased in the observation group measured at the time of starting transferring, 3 0,6 0,9 0,120, and 150 min after the starting of transferring （ P 〈0. 05）. There were no substantial differences in the MAP levels measured before the administration of propofol and fentanyl, at the time of starting transferring, 3 0 ,and 120 and 150 min after the starting of transferring between the groups （ P 〉 0. 05 ）; however, compared with the control group, the MAP levels were higher in the observation grostarting of transferring （P 〈 0. 05 ）,and they were lower in the observation group at the time of 90 min after the starting of transferring （ P 〈 0. 05 ） . During the whole observation period （ before the administration of propofol and fentanyl, at the time of starting transferring, 3 0,6 0,9 0,120, and 150 min after the starting of transferring）, the Sp02 levels between the two groupsdisplayed no significant differences （P 〉0. 05） . The observation group had lower incidences of airway shiflower incidencesfalling off the bed and less overall adverse events than the control group （ P 〈 0. 05 ）, while there were no significant differences between the two groups in the incidences of vomiting and stress injury （ P 〉 0. 05 ） . Conclusion For transferring invasive mechanical ventilation patients, using the sedative regimen with 2 points assessed by SAS as the controlled target not only ensurethe hemodynamic stability, but also effectively control the occurrence of adverse events.