优化镇静镇痛策略在ICU机械通气患者的应用效果

Application effect of optimized sedation and analgesia strategies in patients with mechanical ventilation in ICU

目的探讨优化镇静镇痛策略在重症监护病房(intensive care unit,ICU)机械通气患者中的应用效果。方法选取2021年5月至2022年5月于云浮市中医院ICU行机械通气的患者110例为研究对象,根据随机数字表法将其分为研究组和对照组,每组各55例。对照组患者给予常规护理;研究组患者给予优化镇静镇痛策略护理,比较两组患者的镇静镇痛效果、认知功能、舒适状况、停药后苏醒时间、机械通气时间及不良反应。结果护理后,两组患者的Richmond躁动–镇静量表(Richmond agitation sedation scale,RASS)评分、重症监护疼痛观察工具(critical-care pain observation tool,CPOT)评分均显著低于本组护理前,舒适状况量表(general comfort questionnaire,GCQ)各维度评分均显著高于本组护理前(P<0.05);研究组患者的RASS评分、CPOT评分、总不良反应率均显著低于对照组,GCQ各维度评分均显著高于对照组,停药后苏醒时间、机械通气时间均显著短于对照组(P<0.05);镇静镇痛24h,两组患者的简易精神状态检查量表(mini-mental state examination,MMSE)评分均显著下降(P<0.05);研究组患者的MMSE评分显著高于对照组(P<0.05)。结论优化镇静镇痛策略护理可达到最佳镇静、镇痛效果,促进苏醒并减少机械通气时间,降低不良反应及对认知功能的影响,提高舒适程度。

Objective To investigate the effect of optimized sedation and analgesia strategies in patients with mechanical ventilation in intensive care unit(ICU).Methods A total of 110 patients receiving mechanical ventilation in the ICU of Yunfu Hospital of Traditional Chinese Medicine from May 2021 to May 2022 were selected as the study objects,and were divided into study group and control group according to random number table method,with 55 cases in each group.The control group was given routine nursing,and the study group were given optimized sedation and analgesia strategies nursing.The sedative and analgesic effects,cognitive function,comfort status,recovery time after drug withdrawal,mechanical ventilation time and adverse reactions were compared between the two groups.Results After nursing,Richmond agitation sedation scale(RASS)score,critical-care pain observation tool(CPOT)of the two groups were significantly lower than those before nursing,and the score of all dimensions of general comfort questionnaire(GCQ)was significantly higher than that before nursing(P<0.05).RASS score,CPOT score and total adverse reaction rate of study group were significantly lower than those of control group,score of all dimensions of GCQ were significantly higher than those of control group,and the recovery time after drug withdrawal and mechanical ventilation time were significantly shorter than those of control group(P<0.05).Sedation and analgesia for 24 hours,the scores of mini-mental state examination(MMSE)in both groups decreased significantly(P<0.05).The MMSE score of study group was significantly higher than that of control group(P<0.05).Conclusion Optimized sedation and analgesia strategies nursing can achieve the best sedation and analgesia effect,promote awakening,reduce mechanical ventilation time,reduce adverse reactions and impact on cognitive function,and improve comfort.