ICU镇静患者实施每日唤醒的效果探究

目的:探讨对ICU镇静患者实施每日唤醒的效果。方法:选取2015年1月~2017年1月我院收治的170例ICU内行机械通气镇静的患者作为研究对象,随机分为对照组和观察组,每组85例。对照组不实施每日唤醒,观察组于入ICU次日起行每日唤醒,比较两组患者的干预效果。结果:观察组的机械通气时间、ICU住院时间、总镇静时间和停药后完全清醒时间均明显短于对照组,差异有统计学意义,P0.05;且观察组的气管切开率和呼吸机相关性肺炎(VAP)发生率均明显低于对照组,差异均有统计学意义,P0.05。结论:对ICU机械通气并行镇静处理患者实施每日唤醒处理效果显著,可缩短患者机械通气时间、ICU住院时间、总镇静时间和停药后完全清醒时间,并可降低气管切开率和呼吸机相关性肺炎发生率。     

每日唤醒在神经科重症患者中的应用

目的:探讨每日唤醒(DIS)应用于神经科行机械通气重症患者中的效果。方法:将符合纳入标准的80例患者按随机数字表法分为观察组(每日唤醒)和对照组(持续镇静)各40例,观察两组机械通气时间、人工气道留置时间、ICU住院时间和护士工作负荷的差异。结果:观察组患者机械通气时间、人工气道留置时间和ICU住院时间低于对照组,但差异无统计学意义(P0.05);而护士工作负荷明显高于对照组,差异有统计学意义(P0.01)。结论:DIS不能显著减少神经科重症患者的机械通气时间、人工气道留置时间和ICU住院时间,同时增加护士临床工作量,故DIS不适用于神经科重症患者。     

每日唤醒对机械通气镇痛镇静患者谵妄干预作用的研究

目的探索每日唤醒方法对接受机械通气和镇痛、镇静治疗的危重患者在谵妄干预中的作用。方法选择2013年5月-2014年8月收治杭州市萧山区第一人民医院重症监护病房(ICU)的252例患者,随机分为观察组和对照组,对照组采取镇痛、镇静药物持续输注;观察组实施每日唤醒。两组患者的镇痛、镇静药物应用均遵循剂量最小化原则,即在保证患者舒适、安全的前提下,尽可能减少药物使用量,并在观察组患者唤醒期间对两组患者同时进行自发呼吸试验,比较两组患者谵妄的发生率、镇痛、镇静药物使用量、机械通气时间、镇静时间及ICU治疗时间、护理相关不良事件(如意外拔管、人机对抗、坠床等)及与原疾病相关并发症的发生率。结果观察组患者谵妄的发生率低于对照组(P0.05),且观察组镇静药物用量、机械通气时间、镇静时间及ICU治疗时间明显低于对照组,差异有统计学意义(P0.05),而两组镇痛药物用量、不良事件及并发症发生率比较差异无统计学意义(P0.05)。结论作为预防过度镇静的方法,每日唤醒可减少机械通气患者镇静药物用量,减少机械通气时间、镇静时间及ICU治疗天数,对预防谵妄的发生具有积极作用。     

每日唤醒在ICU机械通气镇静患者中的应用

目的:探讨每日唤醒在机械通气镇静患者中的应用效果及护理.方法:将76例机械通气超过24h并需持续镇静的患者随机分为唤醒组和对照组各38例,两组均在给予芬太尼镇痛的基础上,给予咪唑安定镇静治疗,唤醒组次日起给予每日唤醒疗法,实施综合性护理干预措施.观察两组患者机械通气时间、住ICU时间、总镇静时间、镇静药物用量、气管切开及呼吸机相关性肺炎(VAP)发生率等指标.结果:唤醒组机械通气时间、住ICU时间、总镇静时间、镇静药物用量、气管切开率及VAP发生率均低于对照组(P＜0.05).结论:在机械通气镇静患者中实施每日唤醒及加强综合护理,可以缩短机械通气时间、住ICU时间、镇静治疗时间,减少气管切开、VAP等并发症的发生率和镇静药物的使用量.     

护士主导的镇静和镇痛安全管理在ICU机械通气患者中的应用

目的探讨护士主导的镇静和镇痛安全管理在ICU机械通气患者中的应用效果。方法选取2014年8月~2015年2月期间ICU进行机械通气治疗的患者68例作为研究对象,按照随机数字表法,将患者随机分为对照组和观察组,每组各34例,对照组给予传统的镇静、镇痛管理方案,观察组给予护士主导的镇静和镇痛安全管理,比较2组患者的机械通气时间、ICU时间、总镇静时间、舒适度和不良事件的发生情况。结果观察组在机械通气时间、ICU时间、总镇静时间、治疗舒适性以及不良事件发生率都明显优于对照组,差异具有统计学意义(P0.05)。结论护士主导的镇静和镇痛安全管理能够有效地缩减ICU机械通气患者的机械通气时间、ICU时间、总镇静时间,提高ICU机械通气患者的治疗舒适性,降低不良事件的发生率,值得临床推广应用。     

机械通气镇静患者每日唤醒核查表的设计及临床应用

目的 :通过设计机械通气镇静患者"每日唤醒核查表",以提高护士对唤醒措施的依从性。方法 :于2013年10月至2014年3月,将"每日唤醒核查表"应用于ICU机械通气镇静需要唤醒的患者,观察护士执行唤醒措施的依从性,患者机械通气时间、镇静时间、镇静药物总量。结果 :使用"每日唤醒核查表"后,护士对唤醒措施的依从性及患者镇静药物总量、总镇静时间、机械通气时间、住ICU时间与实施前比较,差异有统计学意义(P0.05)。结论:应用"每日唤醒核查表",提高了医护人员对唤醒措施的依从性,降低了患者镇静药物的用量,缩短了患者总镇静时间、机械通气时间、住ICU时间,保证了患者安全。此方法简单、可操作性强,医护人员接受程度高。     

集束化护理在机械通气伴镇静患者每日唤醒中的应用

目的探索集束化护理在机械通气伴镇静患者每日唤醒中应用的有效性和可行性。方法选取某院ICU 2013-03-2016-06应用机械通气超过48 h需要镇静治疗的危重患者132例,随机分为观察组66例,对照组66例,观察组将所有需要唤醒患者集中管理,采用集束化护理对患者实施唤醒,对照组按照常规对患者实施唤醒,比较两组患者的机械通气时间、ICU住院时间以及呼吸机相关性肺炎发生率之间的差异。结果观察组患者的机械通气时间、ICU住院时间、呼吸机相关性肺炎发生率均显著低于对照组,差异有统计学意义(P=0.000;P=0.000;P=0.009)。结论每日为患者中断镇静用药,将集束化护理运用到唤醒期间,减少了机械通气时间、ICU住院时间以及呼吸机相关性肺炎的发生率。     

ICU护士主导的目标性镇静镇痛安全管理方案的临床应用效果观察

目的探讨ICU护士主导的目标性镇静镇痛安全管理方案在临床应用中的实际效果。方法选择2016年1月-2017年1月期间在本院ICU住院治疗的84例行气管插管机械通气的患者,按照入院先后顺序将其分为对照组与观察组,其中对照组采用药物镇静镇痛,而观察组则是以ICU护士为主导,由床位医师制定好个性化的镇静镇痛方案,护士对每位患者进行每2 h一次的镇静评估,每4 h一次的镇痛评估,对比两组镇静药物使用剂量、机械通气时间、ICU住院时间以及研究过程中谵妄发生率。结果两组所用镇静药物有丙泊酚、右美托咪定,对照组丙泊酚使用剂量(9845.23±933.62)mg、右美托咪定剂量为(2841.43±274.81)μg,而观察组两种药物的使用剂量分别是(5408.33±437.11)mg、(1548.28±176.25)μg,两组对比差异有统计学意义(P0.05);对照组机械通气时间为(6.76±0.82)d,ICU住院时间为(8.09±1.43)d,而观察组机械通气时间(4.53±0.52)d,ICU住院时间为(5.46±0.82)d,观察组时间明显短于对照组(P0.05);在谵妄发生率对比中,对照组的谵妄发生率为28.57%(12/42),而观察组为9.52%(4/42),差异有统计学意义(P0.05)。结论对ICU患者采取以ICU护士主导的目标性镇静镇痛安全管理方案能够有效提高镇静镇痛的临床效果,减少镇静药物使用剂量,同时缩短患者在ICU的时间,并有效控制了谵妄发生率,确保患者镇静镇痛的安全性,值得临床推广。     

计划镇静用于ICU机械通气患者的临床研究

目的：研究计划镇静应用于ICU机械通气患者的临床效果。方法将100例符合纳入标准ICU机械通气患者随机分为计划镇静组和对照组各50例,计划镇静组实施计划镇静方案,根据Ramsay评分动态调节镇静药物的用量,同时有效实施每日唤醒;对照组为常规按需镇静。评估两组患者机械通气时间、ICU住院时间、呼吸机相关性肺炎、非计划性拔管和 ICU不良经历等。结果计划镇静组与对照组相比,患者机械通气时间、ICU住院时间明显减少,呼吸机相关性肺炎、非计划性拔管发生率降低,且患者ICU不良经历减少,差异均有统计学意义（P＜0.05或P＜0.01）。结论计划镇静可以改善ICU机械通气患者的临床转归,减轻患者的ICU不良经历。     

基于e CASH理念的舒适化浅镇静方案在机械通气患者中的应用效果研究

目的探讨护士为主导,基于eCASH理念的舒适化浅镇静方案在机械通气患者中的应用效果。方法选择2018年10月-2019年5月在我院创伤急救中心接受治疗行经口气管插管且需要镇静、镇痛治疗的患者76例,随机分为对照组、观察组各38例。对照组患者使用常规镇静镇痛方案,观察组患者在此基础上给予护士为主导基于e CASH理念的舒适化浅镇静方案,比较两组患者机械通气时间、镇静镇痛药物使用量、ICU入住时间以及谵妄发生率。结果观察组患者在机械通气时间、镇痛药物用量、镇静药物用量、ICU入住时间、谵妄发生率等方面均低于对照组,差异有统计学意义(P0.05)。结论护士为主导基于e CASH理念的舒适化浅镇静方案能够降低患者机械通气时间、镇静镇痛药物使用量、ICU入住时间和谵妄发生率,具有临床应用价值。     

Daily interruption of sedative infusions and complications of critical illness in mechanically ventilated patients

OBJECTIVE: In critically ill patients receiving mechanical ventilation, daily interruption of sedative infusions decreases duration of mechanical ventilation and intensive care unit length of stay. Whether this sedation strategy reduces the incidence of complications commonly associated with critical illness is not known. DESIGN: Blinded, retrospective chart review. SETTING: University-based hospital in Chicago, IL. PATIENTS: One hundred twenty-eight patients receiving mechanical ventilation and continuous infusions of sedative drugs in a medical intensive care unit. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We performed a blinded, retrospective evaluation of the database from our previous trial of 128 patients randomized to daily interruption of sedative infusions vs. sedation as directed by the medical intensive care unit team without this strategy. Seven distinct complications associated with mechanical ventilation and critical illness were identified: a) ventilator-associated pneumonia; b) upper gastrointestinal hemorrhage; c) bacteremia; d) barotrauma; e) venous thromboembolic disease; and f) cholestasis or g) sinusitis requiring surgical intervention. The incidence of complications was evaluated for each patient's hospital course.One hundred twenty-six of 128 charts were available for review. Patients undergoing daily interruption of sedative infusions experienced 13 complications (2.8%) vs. 26 (6.2%) in those subjected to conventional sedation techniques (p =.04). CONCLUSIONS: Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation reduces intensive care unit length of stay and, in turn, decreases the incidence of complications of critical illness associated with prolonged intubation and mechanical ventilation.     

每日唤醒在机械通气镇静患者中的临床应用

目的探索每日唤醒干预对接受机械通气镇静治疗危重患者的有效性和可行性。方法便利抽样选择2011年8月至2012年12月收治杭州市萧山区第一人民医院重症监护病房(ICU)的177例患者,按照入院时间分为试验组(88例)和对照组(89例),对照组采取镇静药物持续输注,试验组在此基础上实施每日唤醒,比较两组患者镇静药物使用量、机械通气时间、ICU治疗时间、谵妄发生率、护理相关不良事件(如意外拔管、人机对抗、坠床等)及原疾病相关并发症发生率。结果试验组镇静药物用量、机械通气时间、ICU治疗天数明显低于对照组,差异均有统计学意义(均P0.05),两组丙泊酚用量、谵妄发生率、不良事件及相关并发症发生率比较,差异均无统计学意义(均P0.05)。结论每日唤醒是预防机械通气危重患者过度镇静的一项安全有效的措施,对患者预后具有积极意义。     

Daily interruption of sedative infusions in an adult medical–surgical intensive care unit: randomized controlled trial

Title. Daily interruption of sedative infusions in an adult medical–surgical intensive care unit: randomized controlled trial. Aim. This article is a report of a study conducted to determine if a nursing‐implemented protocol of daily interruption of sedative infusions vs. sedation as directed by the intensive care unit team would decrease duration of mechanical ventilation. Background. Continuous rather than intermittent infusion of sedative and analgesic agents leads to greater stability in sedation level, but has been correlated with prolongation of mechanical ventilation and hospitalization of critical care patients. Daily interruption of sedative infusions in mechanically ventilated patients has reduced the duration of mechanical ventilation and length of stay in intensive care. Method. A randomized controlled trial was carried out from November 2004 to March 2006 with 97 patients receiving mechanical ventilation and continuous infusion of sedative drugs in an intensive care unit in Greece. The primary outcome measure was the duration of mechanical ventilation. Secondary outcomes were length of intensive care unit stay, length of hospital stay, overall mortality, total doses of sedative and analgesic medicines and Ramsay scores and duration of cessation of sedative infusions per day. Results. The median duration of mechanical ventilation was 8·7 days vs. 7·7 days (P = 0·7). Length of intensive care unit stay (median: 14 vs. 12, P = 0·5) and in the hospital (median: 31 vs. 21, P = 0·1) was similar between the intervention and control groups. The absence of statistically significant differences in these variables remained when patients with brain injury were examined separately. Conclusion. The nursing‐implemented protocol of daily interruption of sedative infusions was neither beneficial nor harmful compared with usual practice, which has as its primary target the earliest possible awakening of patients.     

Optimizing sedation and analgesia in mechanically ventilated patients--an evidence-based approach

Critically ill, mechanically ventilated patients experience pain and anxiety related to a number of factors, including underlying disease processes, invasive procedures, therapeutic devices, immobility, and even routine nursing care such as turning and positioning. Failure to provide adequate analgesia and sedation has been shown to have detrimental physiological consequences, including an increase in sympathetic nervous activity and ventilator dyssynchrony (Young, Knudsen, Hilton & Reves, 2000). Over-sedation has also given rise to concerns related to prolongation of mechanical ventilation, intensive care unit (ICU) length of stay, and cost. The challenge for the ICU team is to provide comfort while avoiding the consequences of both over- and under-sedation. New strategies show promise and focus on a team approach for the management of sedation and analgesia in critically ill, mechanically ventilated patients. These strategies include the use of sedation protocols, which incorporate nurse-driven dose titration directives, sedation scoring systems, and daily interruption of sedative infusions. This article provides a review of three recent studies evaluating these new approaches to the administration of sedation and analgesia in the adult ICU.     

A critical review of daily sedation interruption in the intensive care unit

Background. Daily sedation interruption (DSI) has been proposed as a method of improving sedation management of critically ill patients by reducing the adverse effects of continuous sedation infusions. Aim. To critique the research regarding daily sedation interruption, to inform education, research and practice in this area of intensive care practice. Design. Literature review. Method. Medline, CINAHL and Web of Science were searched for relevant key terms. Eight research‐based studies, published in the English language between 1995–December 2006 and three conference abstracts were retrieved. Results. Of the eight articles and three conference abstracts reviewed, five originated from one intensive care unit (ICU) in the USA. The research indicates that DSI reduces ventilation time, length of stay in ICU, complications of critical illness, incidence of post‐traumatic stress disorder and is reportedly used by 15–62% of ICU clinicians in Australia, Europe, USA and Canada. Conclusions. DSI improves patients’ physiological and psychological outcomes when compared with routine sedation management. However, research relating to these findings has methodological limitations, such as the use of homogenous samples, single‐centre trials and retrospective design, thus limiting their generalisability. Relevance to clinical practice. DSI may provide clinicians with a simple, cost‐effective method of reducing some adverse effects of sedation on ICU patients. However, the evidence supporting DSI is limited and cannot be generalised to heterogeneous ICU populations internationally. More robust research is required to assess the potential impact of DSI on the physical and mental health of ICU survivors.     

Effectiveness of daily interruption of sedation in sedated patients with mechanical ventilation in ICU: A systematic review

PurposeTo evaluate the effectiveness of daily sedation interruption in patients with mechanical ventilation in intensive care unit (ICU).MethodsThe randomized controlled trials (RCTs) on the application of daily interruption of sedation in sedated patients with mechanical ventilation in ICU were collected through databases including Cochrane library, MEDLINE, Web of Knowledge, Embase, CNKI, CBM and VIP Data. Two reviewers independently assessed the quality of studies and extracted the data. Meta-analysis was conducted on the included studies.ResultsEight RCTs involving 757 patients were included. The daily sedation interruptions could shorten the duration of mechanical ventilation (Z = 5.36, p < 0.0001), length of stay (Z = 2.93, p = 0.003 < 0.05) and reduce the rate of tracheotomy (Z = 3.97, p < 0.00001) in these patients. Additionally, daily sedation interruption was not associated with increased rate of unplanned extubation by the patients (Z = 0.53, p = 0.6 < 0.05).ConclusionThe application of daily interruption of sedation in patients with mechanical ventilation in ICU is safe and effective.     

右美托咪定在慢性阻塞性肺疾病急性发作患者机械通气镇静中的疗效分析

目的：评估右美托味定在慢性阻塞性肺疾病急性发作（AECOPD）患者机械通气镇静中的疗效及安全性。方法：选择60例AECOPD并发呼吸衰竭在ICU接受有创机械通气的患者,按随机数字表法分成右美托咪定组30例和咪达唑仑组30例,观察两组患者镇静的成功率、机械通气时间、ICU住院时间、谵妄发生率、呼吸机相关性肺炎（VAP）的发生率以及心血管不良事件的发生率。结果：两组患者均能达到良好的镇静效果（93．33％：96．67％,P〉0．05）,但右美托咪定组所需吗啡用量明显少于咪达唑仑组[（1．2±0．3）mg／h：（2．5±0．4）mg／h,P〈0．05];右美托咪定组机械通气时间、谵妄发生率、呼吸机相关性肺炎（VAP）的发生率、ICU住院时间均少于咪达唑仑组[（5．22±2．36）d、10％、16．67％、（4．25±1．25）d：（5．63±2．86）d、（2．58±1．36）h、42％、34％、（6．33±2．74）d,P〈0．osJ;右美托咪定组心动过缓发生率较咪达唑仑组高（12％：4%,P〈0．05）,低血压发生率两者相似（22％：20％,P〉0．05）。结论：右美托咪定在起到较好理想镇静效果的同时,所需吗啡应用剂量小,并可以减少机械通气时间、ICU住院时间,减少谵妄发生率,减少呼吸机相关性肺炎发生。其临床不良反应发生率低,安全性较高,可作为AECOPD行机械通气患者镇静的一线用药。     

镇静治疗对手术后重症患者使用机械通气的影响

目的探讨手术后ICU患者行机械通气时镇静治疗的临床应用价值。方法 120例术后需机械通气的ICU患者随机分为两组,A组为镇静组(80例),B组为对照组(40例)。A组又分为A1组40例,用咪唑安定镇静;A2组40例,用丙泊酚镇静;B组不用镇静剂。观察比较A、B两组患者术前、术毕、停机械通气前、停机后2h的临床表现、生命体征和机械通气治疗时间等。结果 A组患者少有恐惧感,脱机时血压、心率平稳;B组患者诉不适较多,脱机时血压、心率均明显升高(P<0.01);B组使用机械通气治疗时间较A组延长,两组间比较有显著性差异(P<0.01)。结论应用镇静剂使手术后机械通气的患者处于浅睡眠状态,能减少恐惧,缩短机械通气治疗时间。     

右美托咪啶对ICU机械通气病人的镇静效果

目的通过比较右美托咪啶和丙泊酚对重症监护病房（ICU）预计机械通气超过3d病人的临床疗效,探讨右美托咪啶对ICU机械通气病人长时间镇静的有效性和安全性。方法将选取的40例行有创机械通气、预计机械通气超过3d的病人随机分到右美托咪啶组（D组,20例）和丙泊酚组（P组,20例）。D组病人给予右美托咪啶负荷剂量1μg/kg,注射时间超过10min后继以0.2~0.7μg·kg-1·h-1维持泵入;P组给予丙泊酚负荷剂量1mg/kg,注射时间超过10min后继以1.0~3.0mg·kg-1·h-1维持泵入,直至撤机。观察并记录镇静前及镇静后30min、1h、3h的镇静躁动评分（SAS评分）、呼吸及血流指标;记录两组机械通气时间及ICU驻留时间;记录镇静期间呼吸、心血管不良事件及谵妄的发生情况。结果两组病人均能达到镇静目标水平SAS评分3~4分,D组和P组SAS评分差异无统计学意义（P〉0.05）。两组镇静后呼吸频率、心率、血压较镇静前显著下降（F=5.33~17.06,P〈0.05）,随输注时间延长呼吸、血流指标有所改善,但各时间点差异无统计学意义（P〉0.05）。两组病人镇静相关不良反应类似（P〉0.05）。D组机械通气时间和ICU驻留时间略短于P组,但差异无统计学意义（P〉0.05）。结论在一定剂量范围内右美托咪啶长时间镇静效果与丙泊酚类似,无明显不良反应,为ICU机械通气病人长期镇静治疗用药提供了新的选择。     

La sédation comme facteur de risque d’infection acquise en réanimation

Sedative and analgesic drugs are routinely and heterogeneously used in mechanically ventilated patients. Several epidemiologic studies suggested a relationship between sedation and intensive care unit (ICU)-acquired infections. Sedation may promote infection, a common complication in the ICU, associated with a high morbidity, mortality, and cost. Prolongation of exposure to risk factors for infection, microaspiration, gastrointestinal motility disturbances, and microcirculatory effects are the main mechanisms by which sedation may favour infection in the critically ill patients. Experimental evidence based on both human and animal studies suggests that sedatives and analgesics may alter the immunologic response to exogenous stimuli. Clinical studies comparing different sedative agents do not provide evidence to recommend the use of a particular agent to reduce the rate of ICU-acquired infection. However, sedation strategies aiming to reduce the duration of mechanical ventilation including daily interruption of sedatives or nursing-implementing sedation protocols should be promoted.