基于多学科协作的镇静和镇痛集束化护理对ICU机械通气患者谵妄和转归的影响

Effect of bundle nursing based on multidisciplinary collaboration on delirium and outcome of mechanical ventilated patients after sedation and analgesia in ICU

目的:探讨基于多学科协作的镇静和镇痛集束化护理对ICU机械通气患者谵妄和转归的影响。方法:选取2020年3月至2022年2月上海市第六人民医院ICU收治且行机械通气的患者为研究对象。按照随机数字表法将患者随机分为对照组(n=46)与观察组(n=46)。对照组实施镇静和镇痛常规护理,观察组实施基于多学科协作的镇静和镇痛集束化护理。比较2组谵妄发生情况及身体约束情况、镇痛药物使用剂量、干预前后睡眠质量及临床结局。结果:与对照组相比,观察组谵妄发生率及身体约束率降低,谵妄开始时间较晚,谵妄持续时间较短,差异均有统计学意义(均P<0.05)。观察组右美托咪定及瑞芬太尼使用剂量均少于对照组(均P<0.05)。干预后,与对照组相比,观察组睡眠总时间、快速眼动睡眠时间延长,睡眠效率增高,睡眠潜伏时间及觉醒时间缩短,差异均有统计学意义(均P<0.05)。2组非计划性拔管及病死率差异均无统计学意义(均P>0.05);观察组机械通气时长及ICU住院时长均短于对照组(均P<0.05)。结论:对ICU机械通气患者实施基于多学科协作的镇静和镇痛集束化护理能降低谵妄发生率,减少镇静和镇痛药物使用剂量,缩短患者治疗时间,促进患者良好转归。

Objective:To explore the effect of sedation and analgesia bundle nursing based on multidisciplinary collaboration on delirium and outcome in ICU patients with mechanical ventilation.Methods:Patients who underwent mechanical ventilation in ICU of our hospital from March 2020 to February 2022 were enrolled in this study.According to the random number table method,the patients were randomly divided into a control group(n=46)and an observation group(n=46).The control group received routine nursing of sedation and analgesia,and the observation group received bundle nursing of sedation and analgesia based on multidisciplinary cooperation.The incidence of delirium,physical restraint,dosage of analgesic drugs,sleep quality before and after intervention,and clinical outcomes were compared between the 2 groups.Results:Compared with the control group,the incidence of delirium and physical restraint rate in the observation group were lower,the onset time of delirium was later,and the duration of delirium was shortened(all P<0.05).The dosage of dexmedetomidine and remifentanil in the observation group was less than that in the control group(both P<0.05).After intervention,compared with the control group,the total sleep time and rapid eye movement sleep time of the observation group were prolonged,the sleep efficiency was increased,the sleep latency and awakening time were shortened,and the differences were statistically significant(all P<0.05).There was no significant change in unplanned extubation and mortality between the 2 groups(both P>0.05).The duration of mechanical ventilation and the length of ICU stay in the observation group were shorter than those in the control group,and the cost of ICU hospitalization was less than that in the control group(all P<0.05).Conclusion:The implementation of sedation and analgesia bundle nursing based on multidisciplinary collaboration for ICU patients with mechanical ventilation can reduce the incidence of delirium,reduce the dosage of sedative and analgesic drugs,shorten the treatment time of patients,and promote the good outcome of patients.