ICU术后机械通气患者镇静水平及其影响因素研究

Investigation on sedation level and influencing factors in postoperative patients with mechanical ventilation in ICU

目的了解ICU术后机械通气患者的镇静管理现状,并探讨镇静水平的影响因素及其对患者预后的影响。方法于2018年6月11日至10月30日,选取复旦大学附属中山医院外科监护室163例符合要求的机械通气患者作为研究对象,记录患者的一般资料、ICU治疗情况以及镇静评分。结果163例入组患者共进行机械通气11261.62 h,在此期间护士评估并记录的镇静评分量表(RASS)评分为2815次,其中有80.3%(2261/2815)的RASS评分为浅镇静,17.4%(490/2815)为镇静较深,2.3%(64/2815)为镇静不足;根据指南推荐的镇静水平将患者分为镇静理想组和镇静非理想组,分析患者镇静水平的影响因素发现,相比于男性来说,女性患者的镇静管理水平更为理想(OR值为0.39,P<0.05);使用咪达唑仑会增加患者镇静不理想的风险(OR值为5.60,P<0.05);对患者进行镇静评估的间隔越长,其镇静不理想的风险就越大(OR值为1.70,P<0.05)。此外,镇静非理想组患者的气管切开率(χ^2值为9.70,P<0.01)、ICU住院时间(U值为-2.33,P<0.05)及住院费用(t值为-4.26,P<0.01)显著高于镇静理想组患者。结论患者的镇静水平与镇静药物类型、镇静评估间隔密切相关,镇静水平与患者的不良预后密切相关。本研究为临床镇静管理以及制订合理的镇静评估策略提供参考和依据。

Objective To investigate sedation level for postoperative patients with mechanical ventilation in ICU,and to explore the related factors and patient outcomes with different sedation level.Methods Totally 163 postoperative ICU patients from 11th June to 30th October 2018 were prospectively analyzed.Medical information and all the RASS(Richmond Agitation Sedation Scale)scores was recorded by nurses.Results The 163 enrolled patients received 11261.62 hours mechanical ventilation therapy,and 2815 RASS scores were assessed and recorded by nurses.Among these scores,80.3%(2261/2815)were at light sedation level,while 17.4%(490/2815)and 2.3%(64/2815)were at excessive or insufficient sedation level,respectively.All patients were divided into satisfactory sedation group and unsatisfactory sedation group according to the recommendations of guidelines,and used both univariate analysis and multivariate analysis.Compared to males,female patients tend to be in a satisfactory sedation level(OR value was 0.39,P<0.05);use of midazolam may increase the risk of unsatisfactory sedation level(OR value was 5.60,P<0.05);the longer sedation assessment interval(OR value was 1.70,P<0.05),the more likely the patient′s sedation level is unsatisfactory(OR value was 1.70,P<0.05).Patients in sedation unsatisfactory group have higher rate of tracheostomy(χ^2 value was 9.70,P<0.01),longer ICU stay(U value was-2.33,P<0.05)and more medical expense(t value was-4.26,P<0.01).Conclusion The current sedation management in our ICU is satisfactory,but there is still a small part of patients in a state of insufficient sedation or excessive sedation.Sedation level is closely related to sedatives,RASS assessments interval performed by the nurses.This study provides a reference and basis for clinical sedation management and the sedation assessment strategies in the ICU.