不同镇静深度对重症监护病房机械通气患者预后的影响

Effect of different sedation depth on prognosis of patients with mechanical ventilation in ICU

摘要:

目的  探讨轻度和常规镇静对重症监护病房（ICU）机械通气患者预后和炎症水平的影响。方法  选取2013年5月-2014年4月在该院ICU病房行机械通气的100例多发伤患者为对照组，实施常规镇静；选取同期该院ICU病房行机械通气的100例多发伤患者为观察组，实施轻度镇静。比较两组患者药物使用量、机械通气持续时间、住ICU时间、总住院时间、不良反应及炎症因子水平等。结果  观察组舒芬太尼、丙泊酚、咪唑安定的人均用量与对照组比较，差异有统计学意义（P <0.01），观察组低于对照组；观察组患者的机械通气时间、住ICU时间及总住院时间与对照组比较，差异有统计学意义（P <0.01），观察组比对照组短；观察组患者的不良反应发生率与对照组比较，差异有统计学意义（P <0.05）。观察组患者的C反应蛋白、无激素活性的降钙素前肽物质水平与对照组比较，差异有统计学意义（P <0.05），观察组低于对照组。结论  轻度持续镇静可缩短患者机械通气时间，减少ICU住院及总住院时间，减少不良反应，并能降低炎症因子水平。

Abstract:

Objective To investigate the effect of mild sedation and routine sedation on the prognosis and inflammation in patients with mechanical ventilation in the intensive care unit (ICU). Methods Two hundred cases of multiple-trauma patients, who required mechanical ventilation from May 2013 to April 2014 in the ICU of our hospital, were selected. They were devided into the control group and the observation group with 100 in each group. The patients in the control group had routine sedation, while those in the observation group had mild sedation. Amount of drug use, duration of mechanical ventilation, time of ICU stay, total duration of hospital stay, adverse reactions, inflammatory factor levels and so on were compared between the two groups. Results The per capita amount of Sufentanil, Propofol and Midazolam in the observation group was significantly smaller than that in the control group (P < 0.01). The mechanical ventilation time, duration of ICU stay and hospital stay in the observation group were significantly shorter than those in the control group (P < 0.01). There was a significant difference in the incidence of adverse reactions between the observation group and the control group (P < 0.05). The levels of CRP and PCT in the observation group were significantly lower than those in the control group (P < 0.05). Conclusions Mild continuous sedation can shorten the time of mechanical ventilation and the duration of hospital and ICU stay in multiple-trauma patients, reduce adverse reactions and lower inflammatory factor levels.