ABCDE镇痛镇静策略在重症机械通气患者中的应用分析

Application analysis of ABCDE analgesic and sedative strategy in patients with severe mechanical ventilation

目的探析重症机械通气患者应用ABCDE镇痛镇静策略的临床作用。方法选取76例重症机械通气患者随机分为对照组(38例,常规镇痛镇静策略)与研究组(38例,ABCDE镇痛镇静策略)。对比两组患者28d生存率、两组存活患者镇痛镇静药物使用剂量、机械通气时间、重症加强护理病房(ICU)住院时间、不良事件,并对两组呼吸力学指标进行观察比较。结果研究组28d生存率显著高于对照组(P<0.05);研究组舒芬太尼、咪达唑仑使用剂量显著少于对照组(P<0.05),机械通气时间、ICU住院时间显著短于对照组(P<0.05);研究组不良事件发生率显著低于对照组(P<0.05);组间比较,研究组在干预后第3天、第5天、第7天Ppeak、Pplat明显低于对照组,且Cd、VT明显高于对照组,差异具有统计学意义(P<0.05);组内比较,研究组干预后第3天、第5天、第7天Ppeak、Pplat明显较干预前有所下降,Cd、VT较干预前有所上升(P<0.05),对照组干预后第5天、第7天Ppeak、Pplat与干预前比较有所上升(P<0.05),VT与对照组比较有所下降,干预后第7天Cd较干预前有所上升,差异具有统计学意义(P<0.05)。结论重症机械通气患者应用ABCDE镇痛镇痛静策略可提升患者生存率、减少镇痛镇静药物用量与不良事件、缩短机械通气时间与ICU住院时间,并能够改善患者呼吸力学指标,对改善治疗结局具有重要意义。

Objective To analyze the clinical role of ABCDE analgesic and sedative strategy in patients with severe mechanical ventilation. Methods 76 patients with severe mechanical ventilation were randomly divided into a control group (n=38, routine analgesic and sedative strategy) and a study group (n=38, ABCDE analgesic and sedative strategy). The 28-day survival rate, the dose of analgesic sedative drugs taken by the patients survived, the time of mechanical ventilation, the length of stay in the intensive care unit (ICU), and adverse events were compared between the two groups. Results The survival rate in the study group was significantly higher than that in the control group (P<0.05). The doses of Sufentanil and Midazolam in the study group were significantly lower than those in the control group (P<0.05). The mechanical ventilation time and length of stay in the ICU were significantly shorter than the control group (P<0.05). The incidence of adverse events in the study group was significantly lower than that in the control group (P<0.05);Compared with the control group, on the 3rd, 5th, 7th dppeak and ppl at in the study group were significantly lower than those in the control group, and CD and vt were significantly higher than those in the control group (P<0.05). Compared with the control group, the study group decreased significantly on the 3rd, 5th, 7th dppeak and ppl at after intervention, and increased CD and vt (P<0.05), while the control group increased on the 5th, 7th dppeak and ppl at after intervention (P<0.05), and vt decreased compared with the control group, and increased on the 7th dcd after intervention (P<0.05). Conclusion The application of ABCDE analgesia and analgesia strategy in patients with severe mechanical ventilation can improve the survival rate of patients, reduce the dosage of analgesic and sedative drugs and adverse events, shorten the time of mechanical ventilation and ICU stay, and improve the respiratory mechanics index of patients, which is of great significance to improve the treatment outcome.