Department of Critical Care Medicine, The Second Affiliated Hospital, Chinese People's Liberation Army General Hospital, Beijing 100091, China.
J Crit Care. 2010 Sep;25(3):451-7. doi: 10.1016/j.jcrc.2009.11.006. Epub 2010 Jan 8.
The purpose of this study was to investigate sedation practices and the perception of discomfort during mechanical ventilation in Chinese intensive care units (ICUs).
A prospective, observational, cohort study was conducted in 31 Chinese ICUs in academic hospitals from June 15 to August 15, 2006. Conscious patients who were discharged from the ICU after mechanical ventilation were consecutively included. Using a standardized questionnaire, a personal interview was conducted with each patient within 2 days after discharge from the ICU. Patients were asked about recollections of emotional and physical discomfort. Sedation and analgesia administration data were collected from patient records.
As prospectively defined, 83 (50.9%) of 163 patients met criteria for complex-mixed discomfort (ie, at least 1 emotional and 2 physical disturbances). Similarly, 79.1% of patients remembered seriously uncomfortable experiences associated with 1 of the 3 predefined sources. Both protocolized sedation and continuous sedation without a defined protocol, but not intermittent sedation, significantly reduced the relative risk of complex-mixed discomfort occurrences (P < .001). Notably, only 14.7% of patients received protocolized sedation, and 61 (37.4%) of 163 were not given any sedatives.
Mechanically ventilated ICU patients in Chinese academic hospitals were inadequately treated for discomfort. Protocolized sedation can effectively improve patient comfort.
本研究旨在调查中国重症监护病房（ICU）机械通气镇静实践和不适感的认知情况。
2006 年 6 月 15 日至 8 月 15 日，在 31 家学术医院的中国 ICU 中进行了一项前瞻性、观察性、队列研究。连续纳入机械通气后从 ICU 出院的有意识患者。使用标准化问卷，在 ICU 出院后 2 天内对每位患者进行个人访谈。患者被问及对情绪和身体不适的回忆。从患者记录中收集镇静和镇痛药物管理数据。
如前瞻性定义，163 例患者中有 83 例（50.9%）符合复杂混合性不适标准（即至少存在 1 种情绪和 2 种躯体障碍）。同样，79.1%的患者记得与 3 个预设来源之一相关的严重不适体验。有明确方案的镇静和无明确方案的持续镇静，但不是间歇性镇静，均显著降低了复杂混合性不适发生的相对风险（P<.001）。值得注意的是，只有 14.7%的患者接受了有明确方案的镇静，而 163 例患者中有 61 例（37.4%）未接受任何镇静剂。
中国学术医院的机械通气 ICU 患者在不适方面的治疗不足。有明确方案的镇静可以有效改善患者的舒适度。
