基于不同RASS评分的镇静方案在脓毒症休克患者中的应用

Application of sedation scheme based on different RASS scores in patients with septic shock

目的探讨不同RASS评分的镇静方案在脓毒症休克患者中的应用效果。方法选取2019年1月至2021年1月新疆维吾尔自治区人民医院重症医学科收治的82例脓毒症休克患者,依据随机数字表法分为研究组(n=41)及对照组(n=41)。两组患者进入ICU后均给予对症干预,在此基础上参照RASS评分给予对应镇静方案,研究组将RASS评分维持于-3~-4分,对照组将RASS评分维持于0~-2分。统计两组患者镇静前后心肌损伤相关指标[心肌肌钙蛋白I(cTnI)、cTnT、脑钠肽(BNP)]水平、血气指标[动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))]水平、免疫功能相关指标(NK、CD3^(+)、CD4^(+))、SOFA、APACHEⅡ评分、机械通气时间、ICU入住时间、28天病死率。结果镇静3天后两组患者cTnI、cTnT、BNP水平较镇静前降低,且研究组低于对照组、差值大于对照组(P<0.05);镇静3天后两组PaO_(2)水平较镇静前增高,PaCO_(2)水平较镇静前降低,且研究组PaO_(2)水平高于对照组,PaCO_(2)水平低于对照组、差值大于对照组(P<0.05);干预后两组患者NK水平较干预前降低,CD3^(+)、CD4^(+)水平较干预前增高,且研究组优于对照组、差值大于对照组,差异均有统计学意义(P<0.05);镇静3天后两组患者SOFA、APACHEⅡ评分较镇静前降低,且研究组低于对照组、差值大于对照组(P<0.05);研究组机械通气时间、ICU入住时间短于对照组,差异有统计学意义(P<0.05),28天病死率(14.63%)与对照组(19.51%)比较,差异无统计学意义(P>0.05)。结论脓毒症休克患者镇静干预中将RASS评分维持于-3~-4分可能更利于有效保护心肌,调节血氧状态及机体免疫功能,缩短机械通气和ICU入住时间。

Objective To explore the application effect of sedation scheme based on different RASS scores in patients with septic shock.Methods A total of 82 patients with septic shock in People’s Hospital of Xinjiang Uygur Autonomous Region from January 2019 to January 2021 were selected and randomly divided into study group(n=41)and control group(n=41).Two groups of patients were given symptomatic intervention after entering ICU,on the basis of which,the corresponding sedation scheme was given according to RASS score.The RASS score of the study group was maintained at-3~-4,while the RASS score of the control group was maintained at 0~-2.The levels of cardiac troponin I(cTnI),cTnT,brain natriuretic peptide(BNP),blood gas index(PaO_(2)、PaCO_(2)),immune function index(NK、CD3^(+)、CD4^(+)),sofa,ApacheⅡscore,mechanical ventilation time,ICU stay time,28 day mortality rate were counted before and after sedation.Results After three days of sedation,the levels of cTnI,cTnT and BNP in the two groups were lower than those before sedation,and the difference in the study group was lessobvious than that in the control group(P<0.05).After three days of sedation,the PaO_(2)level in the two groups was higher than that before sedation,and the PaO_(2)level in the study group was higher than that in the control group,the PaO_(2)level was lower than that in the control group,and the difference was greater than that in the control group(P<0.05).After the intervention,the levels of NK in the two groups were lower than those before the intervention,and the levels of CD3^(+),CD4^(+)were higher than those before the intervention,and the study group was better than the control group(P<0.05).The scores of sofa and ApacheⅡin the two groups were lower than those before sedation,and the scores in the study group were lower than those in the control group(P<0.05).The time of mechanical ventilation and ICU stay in the study group were shorter than those in the control group(P<0.05),and there was no significant difference between the 28 day mortality(14.63%)and the control group(19.51%)(P>0.05).Conclusion Maintaining RASS score between-3 and-4 in sedation intervention for septic shock patients can protect myocardium,regulate blood gas status and immune function,alleviate the patient's condition,and shorten the time of mechanical ventilation and ICU stay.