基于eCASH理念的最小化镇静策略联合早期目标导向活动护理应用于行机械通气患者的效果

Effect of the minimal sedation strategy combined with early goal-oriented mobilization nursing based on eCASH concept on patients undergoing mechanical ventilation

目的探究基于以患者为中心的舒适化镇痛镇静(eCASH)理念的最小化镇静策略联合早期目标导向活动护理应用于行机械通气患者的效果。方法研究对象为2019年2月至2021年8月在南华大学附属第二医院行机械通气的80例患者,以随机数字表法将所有患者分为2组(对照组和观察组),每组40例。对照组采用常规护理干预联合早期目标导向活动支持,在此基础上,观察组加用基于eCASH理念的最小化镇静策略干预,比较2组患者的干预效果。结果相比于对照组,观察组的重症监护室入住时间、机械通气时间及总住院时间均较短,镇痛镇静药物使用次数较少,并发症总发生率较低(P均<0.05)。出院1个月及3个月后,2组的用力肺活量、呼气峰值流速和第1秒用力呼气容积与用力肺活量的比值均比入院时高,丙二醛、超氧化物歧化酶和谷胱甘肽过氧化物酶水平均比入院时低(P均<0.05);与同期对照组相比,观察组的呼吸功能和氧化应激指标均更优(P均<0.05)。结论基于eCASH理念的最小化镇静策略联合早期目标导向活动护理能够改善行机械通气患者的呼吸功能,缩短其恢复时间,降低其氧化应激反应,并减少并发症的发生。

Objective To explore the effectiveness of minimal sedation strategy based on patientcentered eCASH(early Comfort using Analgesia,minimal Sedatives and maximal Humane care)concept combined with early goal-oriented mobilization nursing in patients undergoing mechanical ventilation.Methods A study was conducted on 80 patients who underwent mechanical ventilation at the Second Hospital,University of South China from February 2019 to August 2021.The participants were divided into two groups(control group and observation group)using a random number table method,with 40 patients in each group.The control group received routine nursing intervention combined with early goaloriented mobilization support.On this basis,the observation group received minimal sedation strategy intervention based on the eCASH concept,and the intervention effects of the two groups of patients were compared.Results Compared with the control group,the observation group had shorter ICU stay time,mechanical ventilation time,and total hospital stay,fewer use of analgesics and sedatives,and lower overall incidence of complications(all P<0.05).At 1 and 3 months after discharge,the forced vital capacity,peak expiratory flow rate,and the ratio of forced expiratory volume in the first second over forced vital capacity in both groups were higher than those at admission,while the levels of malondialdehyde,superoxide dismutase,and glutathione peroxidase were lower than those at admission(all P<0.05).Compared with the control group during the same period,the respiratory function and oxidative stress indicators in the observation group were all better(all P<0.05).Conclusion The combination of minimal sedation strategy based on eCASH concept and early goal-oriented mobilization nursing can improve respiratory function of patients undergoing mechanical ventilation,shorten the recovery time,reduce oxidative stress response,and reduce the occurrence of complications.