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ABCDE 集束化干预方案对机械通气患者血流动力学的影响。

Effects of ABCDE Bundle on Hemodynamics in Patients on Mechanical Ventilation.

机构信息

Department of Critical Care Medicine, 1st Affiliated Hospital of Medical College, Shihezi University, Shihezi, Xinjiang, China (mainland).

Department of Critical Care Medicine, 1st Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang, China (mainland).

出版信息

Med Sci Monit. 2017 Sep 28;23:4650-4656. doi: 10.12659/msm.902872.

Abstract

BACKGROUND Mechanical ventilation is an important part of advanced life support in the intensive care unit (ICU). This study aimed to investigate the effects of ABCDE bundle on hemodynamics in patients on mechanical ventilation (MV). MATERIAL AND METHODS This study used a cross-sectional overall controlled approach in which 143 patients on mechanical ventilation were divided into 2 groups. In the pre-ABCDE bundle group (n=70), conventional sedation and analgesia strategy were used. In the post-ABCDE bundle group (n=73), ABCDE bundle was used. Changes in hemodynamics parameters and related prognostic indicators were monitored at various time points before (T0) and at 1 d (T1), 3 d (T3), 5 d (T5), and 7 d (T7) after implementation of the 2 strategies. RESULTS Mean arterial blood pressure (MAP), central venous pressure (CVP), heart rate (HR), and oxygenation index (PaO2/FiO2) in the bundle group were improved more significantly than those in the pre-ABCDE bundle group (P<0.05). For comparison between various monitoring time points in the same group, compared with before intervention, MAP, CVP, HR, and PaO2/FiO2 changed significantly in the bundle group at 3 d, 5 d, and 7 d after intervention, and the difference was statistically significant (P<0.05). Compared with before intervention, differences in all hemodynamics indicators were statistically significant in the pre-ABCDE bundle group at 5 d and 7 d after intervention (P<0.05). Compared with the pre-ABCDE bundle group, differences in prognostic indicators in the post-ABCDE bundle were statistically significant (P<0.05). CONCLUSIONS ABCDE bundle is safe and effective for patients on mechanical ventilation, and can improve hemodynamics and enhance oxygenation index. ABCDE bundle might be helpful in reducing 28-d mortality and improving prognosis.

摘要

背景

机械通气是重症监护病房(ICU)高级生命支持的重要组成部分。本研究旨在探讨 ABCDE 捆绑对机械通气(MV)患者血流动力学的影响。

材料与方法

本研究采用横断面整体对照方法,将 143 例机械通气患者分为 2 组。在 ABCDE 捆绑前组(n=70)中,使用常规镇静和镇痛策略。在 ABCDE 捆绑后组(n=73)中,使用 ABCDE 捆绑。在实施 2 种策略前后的不同时间点(T0)和 1 天(T1)、3 天(T3)、5 天(T5)和 7 天(T7)监测血流动力学参数和相关预后指标的变化。

结果

捆绑组的平均动脉压(MAP)、中心静脉压(CVP)、心率(HR)和氧合指数(PaO2/FiO2)改善更明显,与 ABCDE 捆绑前组相比差异有统计学意义(P<0.05)。对于同一组内各监测时间点的比较,与干预前相比,捆绑组在干预后 3、5、7 天的 MAP、CVP、HR 和 PaO2/FiO2 均有明显变化,差异有统计学意义(P<0.05)。与干预前相比,ABCDE 捆绑前组在干预后 5、7 天的所有血流动力学指标差异均有统计学意义(P<0.05)。与 ABCDE 捆绑前组相比,ABCDE 捆绑后组的预后指标差异有统计学意义(P<0.05)。

结论

ABCDE 捆绑对机械通气患者安全有效,可改善血流动力学,提高氧合指数。ABCDE 捆绑可能有助于降低 28 天死亡率,改善预后。

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