儿童心脏重症镇痛、镇静及谵妄实践现状及特点的多中心调查

A multicenter survey on the situation and characteristics of severe cardiac analgesia,sedation and delirium in children

目的了解国内儿童心脏重症镇痛、镇静及谵妄实践的现状及特点,为规范化儿童心脏重症镇痛、镇静及谵妄预防流程奠定研究基础。方法本研究为横断面研究。采用问卷调查法,根据共识、临床建议结合临床实际自行设计镇痛、镇静及谵妄实践现状问卷,于2021年8月通过"国家儿童医学中心儿科护理联盟小儿先心护理学组"向组内儿童专科医院拥有儿童心脏重症监护室(ICU)的ICU发放电子问卷,最终纳入15家ICU。15家ICU均完成本次调查,问卷有效回收率为100%。结果本次调查中的15家ICU均有疼痛评估制度,其中11家有疼痛评估标准操作规程,8家有镇静评估标准操作规范,4家会对患儿进行谵妄评估,但尚无ICU对谵妄评估形成具体的流程或制度。15家ICU均会使用镇痛药物,8家在心脏术后即刻启用阿片类药物镇痛,5家由医生根据患儿情况决定是否启用镇痛药物,2家根据疼痛评分启用镇痛药物,非术后患儿首选非甾体类对乙酰氨基酚,6家会根据疼痛评分启用镇痛药物。15家ICU均会使用镇静药物,6家在入科1h内会启用镇静药物,6家由医生根据患儿情况决定是否启用镇静药物,3家根据镇静评分启用镇静药物,7家首选使用咪达唑仑镇静;15家ICU中有6家开展了"ABCDEF"谵妄预防方案中的部分项目。结论本次调查中的ICU镇痛镇静药物使用异质性较大,镇痛、镇静评估流程尚未建立,谵妄未引起足够重视。合理的镇静镇痛需要制订规范化的镇痛镇静评估流程,目前仍需进行更多高质量的临床研究,为规范化流程的构建提供数据支持。

Objective To explore the situation and characteristics of the practice of severe cardiac analgesia,sedation and delirium in children in China,so as to lay a research foundation for standardizing the prevention process of severe cardiac analgesia,sedation and delirium in children.Methods This study was a cross-sectional study,using questionnaire survey.The Analgesia,Sedation and Delirium Practice Questionnairewas designed according to consensus,clinical suggestions and clinical practice.In August 2021,the electronic questionnaire was issued to the Children's Cardiac Intensive Care Unit(ICU)in children's hospitals through the Pediatric Nursing Alliance Pediatric Congenital Nursing Group of the National Children's Medical Center.A total of 15 ICUs were included,all of which completed the survey,and the effective recovery rate of the questionnaire was 100%.Results The 15 ICUs all had pain assessment system,including 11 with pain assessment standard operating procedures,8 with sedation assessment standard operating procedures,and 4 with delirium assessment.However,there was no specific process or system for delirium assessment in ICU.All 15 ICUs used analgesics,8 of them used opioids for analgesia immediately after cardiac surgery,5 of them used analgesics according to the patient's condition,2 of them used analgesics according to the pain score.Non-steroidal paracetamol was the first choice for non-postoperative children,and 6 of 15 ICUs used analgesics according to the pain score.All 15 ICUs used sedative drugs,6 of which used sedative drugs within 1 hour after admission,6 of which were decided by the doctor according to the situation of the child,3 of which used sedative drugs according to the sedation score,and 7 of which used midazolam as the first choice.A total of 6 the 15 ICUs carried out some projects in the"ABCDEF"delirium prevention program.Conclusions In this investigation,the use of analgesic and sedative drugs in ICU is heterogeneous,the evaluation process of analgesia and sedation has not been established,and delirium has not attracted enough attention.Rational sedation and analgesia need to develop standardized sedation and analgesia evaluation procedures.At present,high-quality clinical studies are still needed to provide data support for the construction of standardized processes.