持续镇静与间断镇静对ICU神经重症患者镇静效果及生存率的影响比较

Comparison on Influence of Continuous Sedation and Intermittent Sedation on Sedation Effect and Survival Rate of ICU Patients with Severe Neuroinjury

目的比较持续镇静与间断镇静对重症监护病房(ICU)神经重症患者镇静效果及生存率的影响。方法将我院收治的100例ICU神经重症患者随机分为持续镇静组(n=50,持续镇静)与每日中断组(n=50,间断镇静),观察两组的临床指标、炎性因子水平、并发症及预后。结果每日中断组的机械通气时间、镇静时间、停药后完全清醒时间、 ICU住院时间及总住院时间均短于持续镇静组(P <0.05)。治疗后,两组的炎性因子(IL-6、 TNF-α)水平均显著降低(P <0.05),且每日中断组的炎性因子水平低于持续镇静组(P <0.05)。治疗过程中,每日中断组的谵妄躁动、呼吸机相关性肺炎发生率均低于持续镇静组(P<0.05),但两组患者的30 d病死率比较差异无统计学意义(P>0.05)。结论间断镇静有利于缩短ICU神经重症患者镇静时间及清醒时间,减少谵妄躁动及呼吸机相关性肺炎发生风险,降低病死率。

Objective To compare the influence of continuous sedation and intermittent sedation on sedation effect and survival rate of patients with severe neuroinjury in intensive care unit(ICU). Methods 100 ICU patients with severe neuroinjury in our hospital were randomly divided into continuous sedation group(n = 50, continuous sedation) and daily interruption group(n = 50, intermittent sedation).The clinical indicators, levels of inflammatory factors, complications and prognosis of both groups were observed. Results The mechanical ventilation time, sedation time, complete waking time after drug withdrawal, ICU hospitalization time and total hospitalization time of daily interruption group were shorter than those of continuous sedation group(P <0.05). After treatment, the levels of inflammatory factors(IL-6,TNF-α) significantly decreased in two groups(P <0.05), and the levels of inflammatory factors of continuous sedation group were lower than those of daily interruption group(P <0.05). During treatment, the incidences of delirium and agitation, and ventilator-associated pneumonia in daily interruption group were lower than those in continuous sedation group(P <0.05). No statistical difference was found in the 30 d mortality between two groups(P >0.05). Conclusions Intermittent sedation is beneficial to reduce the sedation time and waking time of ICU patients with severe neuroinjury, reduce the risks of delirium and agitation, and ventilator-associated pneumonia, and reduce the mortality.