Xing Xue-Zhong, Gao Yong, Wang Hai-Jun, Qu Shi-Ning, Huang Chu-Lin, Zhang Hao, Wang Hao, Xiao Qing-Ling, Sun Ke-Lin
Department of Intensive Care Unit, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
World J Emerg Med. 2015;6(2):147-52. doi: 10.5847/wjem.j.1920-8642.2015.02.011.
The present study aimed to determine the short-term and long-term outcomes of critically ill patients with acute respiratory insufficiency who had received sedation or no sedation.
The data of 91 patients who had received mechanical ventilation in the first 24 hours between November 2008 and October 2009 were retrospectively analyzed. These patients were divided into two groups: a sedation group (n=28) and a non-sedation group (n=63). The patients were also grouped in two groups: deep sedation group and daily interruption and /or light sedation group.
Overall, the 91 patients who had received ventilation ≥48 hours were analyzed. Multivariate analysis demonstrated two independent risk factors for in-hospital death: sequential organ failure assessment score (P=0.019, RR 1.355, 95%CI 1.051-1.747, B=0.304, SE=0.130, Wald=50483) and sedation (P=0.041, RR 5.015, 95%CI 1.072-23.459, B=1.612, SE=0.787, Wald=4.195). Compared with the patients who had received no sedation, those who had received sedation had a longer duration of ventilation, a longer stay in intensive care unit and hospital, and an increased in-hospital mortality rate. The Kaplan-Meier method showed that patients who had received sedation had a lower 60-month survival rate than those who had received no sedation (76.7% vs. 88.9%, Log-rank test=3.630, P=0.057). Compared with the patients who had received deep sedation, those who had received daily interruption or light sedation showed a decreased in-hospital mortality rate (57.1% vs. 9.5%, P=0.008). The 60-month survival of the patients who had received deep sedation was significantly lower than that of those who had daily interruption or light sedation (38.1% vs. 90.5%, Log-rank test=6.783, P=0.009).
Sedation was associated with in-hospital death. The patients who had received sedation had a longer duration of ventilation, a longer stay in intensive care unit and in hospital, and an increased in-hospital mortality rate compared with the patients who did not receive sedation. Compared with daily interruption or light sedation, deep sedation increased the in-hospital mortality and decreased the 60-month survival for patients who had received sedation.
本研究旨在确定接受镇静或未接受镇静的急性呼吸功能不全危重症患者的短期和长期预后。
回顾性分析2008年11月至2009年10月期间在最初24小时内接受机械通气的91例患者的数据。这些患者被分为两组：镇静组（n = 28）和非镇静组（n = 63）。患者还被分为两组：深度镇静组和每日中断和/或轻度镇静组。
总体而言，对91例接受通气≥48小时的患者进行了分析。多因素分析显示院内死亡的两个独立危险因素：序贯器官衰竭评估评分（P = 0.019，RR 1.355，95%CI 1.051 - 1.747，B = 0.304，SE = 0.130，Wald = 50483）和镇静（P = 0.041，RR 5.015，95%CI 1.072 - 23.459，B = 1.612，SE = 0.787，Wald = 4.195）。与未接受镇静的患者相比，接受镇静的患者通气时间更长，在重症监护病房和医院的停留时间更长，院内死亡率增加。Kaplan - Meier法显示，接受镇静的患者60个月生存率低于未接受镇静的患者（76.7%对88.9%，对数秩检验= 3.630，P = 0.057）。与接受深度镇静的患者相比，接受每日中断或轻度镇静的患者院内死亡率降低（57.1%对9.5%，P = 0.008）。接受深度镇静的患者60个月生存率显著低于接受每日中断或轻度镇静的患者（38.1%对90.5%，对数秩检验= 6.783，P = 0.009）。
镇静与院内死亡相关。与未接受镇静的患者相比，接受镇静的患者通气时间更长，在重症监护病房和医院的停留时间更长，院内死亡率增加。与每日中断或轻度镇静相比，深度镇静增加了接受镇静患者的院内死亡率并降低了60个月生存率。
