危重患者疼痛观察工具对ICU机械通气患者预后的影响

Impact of the Critical Care Pain Observation Tool on Mechanically Ventilated Patients' Outcomes in the ICU

目的观察中文版危重患者疼痛观察工具(CPOT)对ICU机械通气患者预后的影响。方法采取前后对照、前瞻性观察性研究方法,历时15个月,共纳入分析患者123例(应用CPOT前6个月纳入患者55例,应用CPOT后6个月纳入患者68例,医护培训期3个月),比较应用CPOT前后,患者镇痛、镇静治疗,机械通气时间,住ICU时间,以及创伤后应激综合征(PTSD)评分等结果的差异。结果两组患者一般情况比较,差异无统计学意义(P> 0. 05)。对比两组入ICU第2天24h内镇痛、镇静情况:两组间使用镇痛、镇静药物患者的比例,镇痛、镇静药物的种类,镇静药物的用量以及镇静评分(RASS)比较,差异均无统计学意义;应用CPOT后组,镇痛药物用量较应用CPOT前明显减少(等效吗啡剂量0. 92±0. 57mg/kg vs 0. 80±0. 48mg/kg,P=0. 036)。两组预后对比:应用CPOT后组,机械通气天数呈缩短趋势,但差异无统计学意义[8 (7,10)天vs 7 (6,9)天,P=0. 077],住ICU天数无明显变化[11(8,14)天vs 10 (8,12)天,P=0. 445],PTSD调查问卷结果相似[1 (0,1) vs 1 (0,1),P=0. 680]。结论应用CPOT对ICU机械通气患者进行疼痛评估,能够减少镇痛药物用量,对机械通气时间有缩短趋势。

Objective To investigate the Chinese version of pain observation tool （CPOT）on mechanically ventilated patients′ outcomes in the ICU. Methods This prospective observational study used a before-and-after design. A total of 123 patients were included for analysis during 15months（55 patients were included in 6 months before using CPOT, 68 patients were included in 6 months after using CPOT, all doctors and nurses were trained to use CPOT in three months）.We evaluated the differences of analgesia and sedation managements,mechanical ventilation duration,ICU length of stay,and post traumatic stress disorder performance between the pre-implementation and post-implementation of the CPOT groups. Results Patients′ baseline characteristics were not significantly different. Compared the data of analgesia and sedation management during the 24hours on day 2 of the ICU stay, there were no significantly changes in the proportion of patients who received analgesia and sedation therapy, the agents which were used for analgesia and sedation, the doses of the sedation drugs, and the score of sedation level（RASS） between the two groups. After using the CPOT as pain assessment, patients received lower doses of analgesic drugs（morphine equivalent dose 0.92±0.57mg/kg vs 0.80±0.48mg/kg, P =0.036）. Compared the outcomes with the control group, there was a shortening tendency of the duration of mechanical ventilation without statistical significance [8 （7,10） days vs 7（6,9）days, P =0.077], and no significant difference in ICU length of stay [11 （8, 14）days vs 10（8, 12）days, P = 0.445] and PTSD scores[1（0,1） vs 1（0,1）, P =0.680]in the post-implementation group. Conclusion Pain assessment by using CPOT in mechanically ventilated patients in the ICU is associated with a reduction of the analgesic drugs′ doses and a shortening tendency of the mechanical ventilation duration.