方敏,余鹏
FANG Min,YU Peng

• 1:池州市人民医院重症医学科
• 2:南昌大学第二附属医院内分泌代谢科

摘要(Abstract)：

目的 探讨持续浅镇静对重症监护室（ICU）机械通气患者的镇静效果及认知功能的影响。方法 96例ICU行机械通气治疗的危重症患者均分为试验组和对照组，对照组患者按标准镇静方案进行镇静，试验组则实施持续浅镇静目标导向策略治疗；统计两组患者的镇静药物用量，记录脱机时间、ICU停留时间，比较两组患者在镇静48 h时的血清C反应蛋白（CRP）、白细胞介素-6(IL-6)及降钙素原（PCT）等炎症因子水平，分析两组患者的躁动、非计划拔管、气胸、呼吸机相关性肺炎等不良反应的发生情况，比较两组患者在镇静前、镇静48 h时的认知功能及谵妄的发生情况。结果 试验组患者镇静药物用量少于对照组，脱机时间及ICU停留时间均短于对照组，差异有统计学意义（P<0.001）；试验组患者在镇静48 h时的血清CRP、IL-6及PCT水平均低于对照组，差异有统计学意义（P<0.001）；试验组患者呼吸机相关性肺炎及总不良反应发生率低于对照组，差异有统计学意义（P<0.05）；两组患者镇静48 h时的认知功能评分低于镇静前，且试验组的评分高于对照组，差异有统计学意义（P<0.01）；试验组的谵妄发生率低于对照组，差异有统计学意义（P<0.05）。结论 持续浅镇静目标导向策略对ICU机械通气患者的镇静治疗效果优于标准镇静方案，在降低相关镇静药物的用量同时，还能减轻机体的炎症应激反应，促进患者恢复。
Objective To investigate the influence of sustained moderate sedation on the sedation effect and cognitive function of patients treated with mechanical ventilation in ICU.Methods Ninety-six critically ill patients treated with mechanical ventilation in ICU were divided into an experimental group and a control group. The control group was treated with standard sedation scheme while the experimental group was treated with the goal-oriented strategy of sustained moderate sedation. The dosage of sedative drugs in the two groups was measured, and the offline time and length of stay in ICU were recorded. The levels of inflammatory factors such as C-reactive protein( CRP), interleukin-6(IL-6), and procalcitonin(PCT) at 48 h of sedation in the two groups were compared. The adverse reactions such as restlessness, non-planned extubation, pneumothorax and ventilator-associated pneumonia in the two groups was analyzed. The cognitive function and the occurrence of delirium before sedation and at 48 h of sedation in the two groups were compared.Results The dosage of sedative drugs in the experimental group was less than that in the control group, the offline time and the length of stay in ICU were shorter than those in the control group, and the difference was statistically significant(P< 0. 001). The levels of CRP, IL-6, and PCT in the experimental group at 48 h of sedation were lower than those in the control group, and the difference was statistically significant(P< 0. 001). The incidence of ventilator-associated pneumonia and total adverse reactions in the experimental group was lower than that in the control group, and the difference was statistically significant(P< 0. 05). The scores of cognitive function at 48 h at sedation in the two groups were lower than those before sedation, and the score of the experimental group was higher than that in the control group, with significant difference(P< 0. 01). The incidence of delirium in the experimental group was lower than that in the control group, and the difference was statistically significant(P<0. 05).Conclusion The sedation effect of sustained moderate sedation goal-oriented strategy on patients treated with mechanical ventilation in ICU is better than that of standard sedation scheme. It can also reduce the dosage of relevant sedative drugs, alleviate the inflammatory stress response of the body, and promote the recovery of patients.

关键词(KeyWords)： 重症监护室;机械通气;持续浅镇静;炎症因子;谵妄;不良反应
intensive care unit(ICU);mechanical ventilation;sustained moderate sedation;inflammatory factors;delirium;adverse reactions

Abstract:

Keywords:

基金项目(Foundation): 江西省教育厅科学技术研究项目（GJJ180084）

作者(Author): 方敏,余鹏
FANG Min,YU Peng

DOI: 10.19367/j.cnki.2096-8388.2022.04.016

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