早期目标导向型镇静策略对重症机械通气患者谵妄发生率及镇静效果的影响

Influence of early goal-directed sedation strategy on incidence of delirium and sedation effect in critically ill patients with mechanical ventilation

  • 摘要:
    目的 探讨早期目标导向型镇静策略(EGDS)对重症机械通气患者谵妄发生率及镇静效果的影响。
    方法 选取2019年7月—2021年7月在重症医学科(ICU)住院治疗的200例患者为研究对象, 随机分为观察组和对照组,每组100例。对照组采用标准化镇静策略,观察组采用EGDS策略。比较2组患者干预后的浅镇静率、谵妄发生率、机械通气时间、住院时间、咪达唑仑人均总剂量。
    结果 观察组干预后浅镇静率为56.00%, 高于对照组的37.00%, 差异有统计学意义(P < 0.05)。观察组机械通气时间、住院时间、谵妄发生率依次为(7.68±3.31) h、(10.17±3.88) d、14.00%, 短于或低于对照组的(11.72±3.63) h、(19.21±4.05) d、35.00%, 差异有统计学意义(P < 0.05)。观察组咪达唑仑人均总剂量为(2.55±1.46) mg, 低于对照组的(8.27±2.05) mg, 差异有统计学意义(P < 0.05)。
    结论 EGDS可以维持患者浅镇静状态,减少镇静药物使用剂量,降低谵妄发生率,缩短机械通气时间和住院时间。

     

    Abstract:
    Objective To investigate the influence of early goal-directed sedation strategy (EGDS) on the incidence of delirium and sedation effect in critically ill patients with mechanical ventilation.
    Methods A total of 200 hospitalized patients in the Intensive Care Unit (ICU) from July 2019 to July 2021 were selected as research objects, and they were randomly divided into observation group and control group, with 100 cases in each group. The control group was conducted with standardized sedation strategy, and the observation group was conducted with EGDS strategy. After intervention, the ratio of superficial sedation, incidence of delirium, mechanical ventilation time, hospital stay and the total dose per capita of midazolam were compared between the two groups.
    Results After intervention, the rate of superficial sedation in the observation group was 56.00%, which was significantly higher than 37.00% in the control group (P < 0.05). The mechanical ventilation time, hospital stay and incidence of delirium in the observation group were (7.68±3.31) h, (10.17±3.88) d and 14.00% respectively, which were significantly shorter or lower than (11.72±3.63) h, (19.21±4.05) d and 35.00% in the control group (P < 0.05). The total dose per capita of midazolam in the observation group was (2.55±1.46) mg, which was significantly lower than (8.27±2.05) mg in the control group (P < 0.05).
    Conclusion EGDS can maintain the status of superficial sedation in patients, reduce the dosage of sedatives and the incidence of delirium, and shorten the mechanical ventilation time and hospital stay.

     

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