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[目标导向镇痛对重症监护病房机械通气患者结局的影响:一项临床观察性研究]

[The impact of goal directed analgesia on mechanical ventilated patients's outcomes in intensive care unit: a clinical observational study].

作者信息

Li Q D, Wan X Y, Zhang Y L, Li S W, Han L L, Li W W, Shi H Y

机构信息

Department of Critical Care Medicine, the First Affiliated Hospital of Dalian Medical University, Critical Care Medical Research Institute, Dalian Medical University, Dalian 116011, China.

出版信息

Zhonghua Nei Ke Za Zhi. 2017 Nov 1;56(11):846-848. doi: 10.3760/cma.j.issn.0578-1426.2017.11.014.

Abstract

To investigate the impact of goal directed analgesia on the outcome of patients with mechanical ventilation in intensive care unit.A total of 126 patients who needed mechanical ventilation were recruited.With a method of before and after paired comparison, they were divided into two group: (1) analgesia with empirical administration or control group; (2) goal directed analgesia based on critical-care pain observation tool (CPOT). Compared with the control group, after goal directed analgesia was applied, the consumption of midazolam significantly dropped from (368.47±27.41) mg to (151.27±29.31) mg(<0.05), whereas the consumption of dexmedetomidine significantly increased from (623.62±20.91) μg to (812.34±22.57) μg(<0.05). The median score of Richmond agitation-sedation scale increased from -3 to -1.The incidence of delirium significantly reduced from 23.81% to 17.46%(<0.05). The mean ventilator duration was significantly shortened from (168.49±11.41) h to (142.38±13.24) h(<0.05). ICU length of stay was significantly shortened from (23.64±9.26) d to (19.63±8.46) d(<0.05). Due to the mild sedation, patients receiving goal directed analgesia report less delirium, less ventilation time and shorter ICU length of stay, suggesting that the general outcome is improved.

摘要

探讨目标导向镇痛对重症监护病房机械通气患者预后的影响。共纳入126例需要机械通气的患者。采用前后配对比较的方法,将他们分为两组:(1)经验性给药镇痛组或对照组;(2)基于重症监护疼痛观察工具(CPOT)的目标导向镇痛组。与对照组相比,应用目标导向镇痛后,咪达唑仑的用量从(368.47±27.41)mg显著降至(151.27±29.31)mg(<0.05),而右美托咪定的用量从(623.62±20.91)μg显著增至(812.34±22.57)μg(<0.05)。里士满躁动镇静量表的中位数评分从-3升至-1。谵妄的发生率从23.81%显著降至17.46%(<0.05)。平均机械通气时间从(168.49±11.41)h显著缩短至(142.38±13.24)h(<0.05)。重症监护病房住院时间从(23.64±9.26)d显著缩短至(19.63±8.4)d(<0.05)。由于镇静程度较轻,接受目标导向镇痛的患者谵妄较少,通气时间较短,重症监护病房住院时间较短,提示总体预后得到改善。

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