护理为主导实施的镇静方案对机械通气的重症肺炎患者的临床效果探讨

To explore the Clinical Effect of Nursing-led Sedation Program on Mechanically Ventilated Patients with Severe Pneumonia

目的探讨护理为主导实施的镇静方案对机械通气的重症肺炎患者的临床效果。方法选取2019年1月—2020年1月该院接受机械通气的重症肺炎患者82例,按照随机数字表法,分为对照组与观察组,每组41例。对照组根据医生评估及指导镇静深度、具体唤醒时间,观察组接受护理为主导实施的镇静方案干预,比较两组临床疗效、视觉模拟评分法(VAS)评分、不良反应与意外拔管率。结果观察组镇静药物用量少于对照组(t=5.126, P<0.05),总镇静时间、机械通气时间与ICU住院时间少于对照组(t=17.607、12.189、6.711, P<0.05),氧合指数高于对照组(t=3.080, P<0.05),CPIS评分低于对照组(t=10.418,P<0.05);观察组总有效率为80.49%,高于对照组的58.54%(χ^2=4.661,P<0.05);两组VAS评分[(3.5±0.8)分vs(3.3±0.5)分]、谵妄发生率(17.07%vs 12.20%)与意外拔管率(19.51%vs 21.95%)差异无统计学意义(P>0.05)。结论护理为主导实施的镇静方案应用于机械通气的重症肺炎患者的疗效确切,且不会明显增加不良反应发生。

Objective To explore the clinical effect of nursing-led sedation on mechanically ventilated patients with severe pneumonia. Methods A total of 82 patients with severe pneumonia who received mechanical ventilation in the hospital from January 2019 to January 2020 were selected and divided into a control group and an observation group,41 cases in each group, according to the random number table method. According to the doctor’s assessment and guidance on the depth of sedation and specific wake-up time, the control group received nursing-led intervention with a sedation plan, and compared the clinical efficacy, visual analogue scale(VAS) score, adverse reactions and accidental extubation rates between the two groups. Results The amount of sedative drugs in the observation group was less than that of the control group(t=5.126, P<0.05), and the total sedation time, mechanical ventilation time and ICU hospital stay were less than those in the control group(t=17.607, 12.189, 6.711, P<0.05), the oxygenation index was higher than that of the control group(t=3.080, P<0.05), and the CPIS score was lower than that of the control group(t=10.418, P<0.05);the total effective rate of the observation group was 80.49%, which was higher than 58.54% of the control group(χ^2=4.661, P<0.05);VAS score [(3.5±0.8) points vs(3.3±0.5) points], incidence of delirium(17.07% vs 12.20%) and accidental extubation rate(19.51% vs 21.95%). The difference was not statistically significant(P>0.05). Conclusion The nursing-led sedation program applied to mechanically ventilated patients with severe pneumonia has a definite effect and does not significantly increase the occurrence of adverse reactions.