镇静镇痛集束化策略对行机械通气脑梗死患者谵妄及预后的影响

Effect of sedation and analgesia bundle on delirium and prognosis in cerebral infarction patients receiving mechanical ventilation

目的研究镇静镇痛集束化策略对行机械通气脑梗死患者的谵妄发生率及临床预后的干预效果。方法采用随机对照试验方法,选取2018年1—6月武装警察部队特色医学中心呼吸与重症医学中心重症监护病房(ICU)行机械通气的脑梗死患者60例(35～55岁),按随机数字表法分为对照组(30例)和观察组(30例)。对照组实施常规护理措施(一级护理),观察组在常规护理的基础上进行镇静镇痛集束化干预策略。比较2组患者的ICU住院时间、4周存活率、谵妄发生率有无差异。结果观察组患者ICU住院时间短于对照组[(12±5) d比(17±8) d],差异有统计学意义(t=2. 53,P=0. 014)。观察组患者4周存活率高于对照组[86. 7%(26/30)比63. 3%(19/30)],差异有统计学意义(χ2=4. 36,P=0. 037)。观察组患者谵妄发生率低于对照组[23. 3%(7/30)比66. 7%(20/30)],差异有统计学意义(χ2=11. 38,P=0. 001)。结论镇静镇痛集束化干预措施能够降低ICU行机械通气的脑梗死患者的谵妄发生率,改善患者的临床预后。

Objective To investigate the effect of sedation and analgesia bundle on delirium and the prognosis in cerebral infarction patients undergoing mechanical ventilation. Methods A prospective randomized controlled trail was performed in 60 cerebral infarction patients of 35-55 years old undergoing mechanical ventilation in intensive care unit( ICU) of Characteristic Medical Center of Chinese People’ s Armed Police Forces between January and June 2018. The patients were randomly divided into control group treated by routine nurisng( first class) and observation group treated by sedation and analgesia bundle on the basis of routine nursing,with 30 cases in each group. Length of ICU stay,4-week survival rate and incidence of delirium were analyzed. Results ICU duration in the intervention group was significantly shorter than that in the control group[( 12 ± 5) d vs( 17 ± 8) d]( t = 2. 53,P = 0. 014). The 4-week survival rate in the intervention group was significantly higher than that in the control group[86. 7%( 26/30) vs 63. 3%( 19/30) ]( χ2= 4. 36,P = 0. 037). The incidence of delirium in the intervention group was significantly lower than that in the control group[23. 3%( 7/30) vs 66. 7%( 20/30) ]( χ2=11. 38,P = 0. 001). Conclusion Application of sedation and analgesia bundle can reduce the incidence of delirium and improve the clinical outcome of cerebral infarction patients undergoing mechanical ventilation.