基于eCASH理念的镇静、镇痛护理在ICU机械通气病人中的应用

Application of sedation and analgesia nursing based on the eCASH concept for mechanically ventilated ICU patients

目的:探讨基于舒适化浅镇静策略(eCASH)理念的镇静、镇痛护理在ICU气管插管机械通气病人中的应用效果。方法:选取2017年1月1日—2018年12月31日我院ICU收治的60例气管插管机械通气病人,采用随机数字表法分为对照组和观察组各30例,两组病人均给予瑞芬太尼镇痛、机械通气及呼吸机相关护理措施,对照组使用常规咪达唑仑镇静护理,观察组使用右美托咪定进行基于eCASH理念的镇静镇痛护理。比较两组病人用药后镇静达标时间、镇静躁动评分(RASS)、停镇静药后清醒时间、转机械通气治疗率、机械通气时间、ICU入住时间以及ICU入住期间不良事件的发生率。结果:观察组病人镇静达标时间、停镇静药后清醒时间、转机械通气治疗率、机械通气时间、ICU入住时间分别为(18.57±4.82)min、(0.78±0.15)h、3.33%、(8.12±1.80)d、(11.37±1.79)d,对照组病人镇静达标时间、停镇静药后清醒时间、转机械通气治疗率、机械通气时间、ICU入住时间分别为(10.63±1.59)min、(1.60±0.27)h、20.00%、(9.30±1.91)d、(13.77±3.48)d,两组比较差异均有统计学意义(P<0.05);观察组谵妄发生率、血压下降发生率均低于对照组(P<0.05)。结论:气管插管机械通气病人实施基于eCASH理念的镇静镇痛护理,有利于缩短机械通气时间和ICU入住时间,降低ICU入住期间谵妄发生率,血流动力学更平稳。

Objective:To explore the application effect of sedation and analgesia care based on the concept of early comfort using analgesia,minimal sedatives and maximal humane care(eCASH)for mechanically ventilated ICU patients.Methods:A total of 60 mechanically ventilated patients with tracheal intubation admitted to the ICU from January 1,2017 to December 31,2018,were selected and divided into the control group and the observation group by the random number table method,with 30 cases in each group.Both groups of patients received Swiss Fentanyl analgesia,mechanical ventilation,and ventilator‐related nursing measures.The patients in control group received routine midazolam sedative care,and the pationts in observation group used dexmedetomidine for sedative analgesic care based on the eCASH concept.The sedation standard time after medication,Richmond Agitation Sedation Scale(RASS)score,awake time after stopping sedation,mechanical ventilation treatment rate,mechanical ventilation time,length of stay(LOS)in ICU,and the incidence of adverse events during ICU stay were compared between the two g roups of pa tien ts.Results:The standard sedation time,awake time after stopping sedatives,mechanical ventilation treatment rate,mechanical ventilation time,LOS in ICU of the patients in the observation group were(18.57±4.82)min,(0.78±0.15)h,3.33%,(8.12±1.80)d,and(11.37±1.79)d;those in control group were(10.63±1.59)min and(1.60±0.27)h,20.00%,(9.30±1.91)d,and(13.77±3.48)d,respectively.The difference between the two groups was statistically significant(P<0.05);the incidence of delirium and blood pressure reduction in the observation group were lower than those in the control group(P<0.05).Conclusions:The use of sedation and analgesia care based on the concept of eCASH for mechanically ventilated patients with tracheal intubation is beneficial to shorten the time of mechanical ventilation and LOS in ICU,reduce the incidence of delirium during ICU stay,and make hemodynamics more stable.