基于eCASH理念的镇静镇痛护理对ICU机械通气谵妄的预防效果

Effects of sedation and analgesia nursing based on eCASH concept in prevention of delirium of mechanical ventilation in ICU

目的研究基于eCASH(以患者为中心的舒适化浅镇静策略)理念的镇静镇痛护理对ICU机械通气谵妄的预防效果。方法将2016年1月至2018年12月昆山市第三人民医院ICU收治的机械通气患者104例依据随机数表法分为对照组和观察组,每组52例。对照组进行常规镇静镇痛护理,观察组在常规护理基础上加入基于eCASH理念的镇静镇痛护理。对比两组患者ICU住院时间、机械通气时间、呼吸功能及谵妄发生情况。结果观察组患者住ICU时长与机械通气时长均低于对照组(P<0.05);观察组患者的第一种时间肺活量、呼气流速峰值、肺活量、肺总量及潮气量均高于对照组(P<0.05);观察组的谵妄、转科、死亡/放弃治疗发生率均低于对照组(P<0.05)。结论 eCASH理念护理模式强调以患者及其家属为中心,采用最小化镇静及优先镇痛,让患者充分感受到更加人性化的护理,降低了ICU机械通气患者的谵妄发生率,且缩短了患者的恢复时间,促进疾病转归。

Objective To study the effects of sedation and analgesia nursing based on early comfort using analgesia, minimal sedatives and maximal humane care(eCASH) concept in prevention of delirium of mechanical ventilation in ICU. Methods A total of 104 patients who treated with mechanical ventilation in ICU of Kunshan Third People’s Hospital from January 2016 to December 2018 were divided into control group and observation group according to the method of random number table, with 52 cases in each group. The patients in control group were given routine sedation and analgesia nursing, and the patients in observation group were given sedation and analgesia nursing based on eCASH concept on the basis of routine nursing. The ICU stays, mechanical ventilation time, respiratory function and delirium were compared between two groups. Results The ICU stays and mechanical ventilation time in observation group were lower than those in control group(P<0.05). The FEF1.0, PEF, VC, TLC and VT in observation group were higher than those in control group(P<0.05). The incidence of delirium, transferring to other department, death/abandoning treatment in observation group was lower than that in control group(P<0.05).Conclusions The eCASH concept nursing model emphasizes the minimal sedation and preferential analgesia with patients and their families as the center, so that patients can fully feel the humanity of eCASH concept nursing model, which reduces the incidence of delirium in patients with mechanical ventilation in ICU, shortens the recovery time and promotes the outcome of disease.