舒适化浅镇静策略在神经外科重症监护室重型颅脑损伤机械通气患者中的应用研究

Application of early comfort using analgesia minimal sedatives and maximal humane care in patients with severe craniocerebral injury treated by mechanical ventilation in neurosurgical intensive care unit

目的探究舒适化浅镇静策略(eCASH)在神经外科重症监护室(NICU)重型颅脑损伤机械通气患者中的应用效果。方法选取2021年10月至2022年10月南京鼓楼医院收治的48例行机械通气治疗的重型颅脑损伤患者作为研究对象,按照随机数字表法分为观察组(24例)和对照组(24例),观察组采用eCASH策略,对照组予以常规镇静、镇痛护理。比较两组镇静剂用量、机械通气时间、躁动、NICU住院天数、一次性拔管成功率、非计划拔管率和呼吸机相关性肺炎(VAP)的发生率。结果观察组镇静剂用量、机械通气时间及住院天数均短于对照组,一次性拔管成功率高于对照组,躁动发生率低于对照组,差异有统计学意义(P<0.05);对照组和观察组均未出现非计划性拔管,差异无统计学意义(P>0.05)。结论NICU重型颅脑损伤机械通气患者应用eCASH策略,可减少镇静剂的用量,缩短住院天数,降低躁动的发生率,提高一次性拔管成功率,促进疾病的康复。

Objective To explore the application effect of early comfort using analgesia minimal sedatives and maximal humane care(eCASH)in patients with severe craniocerebral injury in neurosurgical intensive care unit(NICU)with mechanical ventilation.Methods A total of 48 patients with severe craniocerebral injury who were treated with mechanical ventilation in Nanjing Drum Tower Hospital from October 2021 to October 2022 were selected as research objects,and they were divided into observation group(24 cases)and control group(24 cases)by random number table method.The observation group was treated with eCASH strategy,and the control group was treated routine sedation and analgesic nursing.The dosage of sedatives,duration of mechanical ventilation,agitation,length of stay in NICU,success rate of one-time extubation,unplanned extubation and incidence of ventilator associated pneumonia(VAP)were compared between the two groups.Results The dosage of sedatives,the time of mechanical ventilation and the days of hospitalization in the observation group were shorter than those in the control group,the success rate of one-time extubation was higher than that of control group,and the incidence of agitation was lower than that of control group,the differences were statistically significant(P<0.05).There was no unplanned extubation between control group and observation group,and the difference was not statistically significant(P>0.05).Conclusion The application of eCASH strategy can reduce the dosage of sedatives,shorten the number of days in hospital,reduce the incidence of agitation,improve the success rate of one-time extubation,and promote the recovery of the disease in NICU patients with mechanical ventilation for severe cranial brain injury.