镇静镇痛集束策略对机械通气患者谵妄及临床预后的干预研究

Effectiveness of sedative and analgesic bundle on delirium and clinical prognosis in mechanically ventilated patients

目的研究ABCDE镇静镇痛集束策略（ABCDE Bundle）对机械通气患者谵妄发生率、临床预后的干预效果。方法采用随机对照试验方法，选取2016年1-12月收治于武警后勤学院附属医院呼吸与重症医学中心ICU行机械通气的22-45岁的机械通气患者84例，将其按照随机数字表法分为干预组和对照组各42例。对照组实施常规护理措施（一级护理），干预组在常规护理措施的基础上进行ABCDE镇静镇痛集束方案。比较2组患者的ICU住院时间、4周存活率、谵妄发生率有无差异。结果干预组患者平均ICU住院时间为（11.76 ± 5.15）d，对照组为（17.64 ± 8.04）d，2组比较差异有统计学意义（t=3.99，P〈0.01）。干预组患者4周存活率和谵妄发生率分别为90.48%（38/42）、66.67%（28/42），对照组分别为71.43%（30/42）、40.48%（17/42），2组比较差异有统计学意义（χ^2=4.94、5.79，P〈0.05）。结论机械通气患者使用ABCDE镇静镇痛集束策略，能够降低ICU住院患者谵妄发生率，改善患者的临床预后。

ObjectiveTo research the intervention effect of the ABCDE Bundle in mechanically ventilated patients.MethodsA prospective randomized controlled trail （RCT） was selected 84 mechanically ventilated patients aged 22-45 years in the ICU of respiratory and severe medical center of the affiliated hospital of Logistics University of PAP from January to December in 2016. The research samples were randomly divided into intervention group （n=42） and control group （n=42）. Samples were chosen to compare the difference of basic situation, ICU length of stay, 28-day hospital survival rate and the incidence of delirium between the patients of intervention group and control group.ResultsThe average ICU hospitalization time in the intervention group was （11.76± 5.15） days, while that in the control group was （17.64 ± 8.04） days, and the difference between the 2 groups was statistically significant （t=3.99, P〈0.01）. The 4-week survival rate and delirium incidence rate in intervention group were 90.48% （38/42） and 66.67% （28/42） respectively, while those in control group were 71.43% （30/42） and 40.48% （17/42） respectively, and the difference between 2 groups was statistically significant （χ^2=4.94, 5.79, P〈0.05）.ConclusionThe application of bundles of care strategy could reduce the incidence of delirium and improve the clinical outcome of mechanically ventilated patients.