江自璇 马可泽 谭子锋 陈素君 赖志君 杨文海

[摘要] 目的 研究舒適性护理在PICU患儿机械通气适度镇静镇痛中的应用效果。 方法 选取我院2019年1月至2020年10月间开展机械通气治疗的患儿48例，按照随机数字表法分为对照组和观察组，每组各24例。两组患儿均给予咪唑安定、芬太尼镇静镇痛治疗，对照组进行常规镇静镇痛护理，观察组开展舒适性护理干预，记录镇静镇痛起效时间、机械通气时间、停药苏醒时间和不良反应镇静程度按照RASS评分进行评估，比较两组患儿护理满意度。 结果 观察组患儿的镇静镇痛起效时间、机械通气时间、停药后苏醒时间、RASS评分等均优于对照组（P<0.05）;镇静镇痛治疗后不良反应主要表现为呼吸抑制、心动过缓、恶心、低血压等，观察组患儿不良反应总发生率为12.50%，明显低于对照组的33.33%（P<0.05）;观察组患儿总满意度为95.84%，明显高于对照组的70.83%（P<0.05）。 结论 小儿机械通气中在使用镇静镇痛药物的同时开展舒适护理干预，能够改善患儿机械通气过程中的心率、血压、呼吸、SpO2，降低机械通气时间及用药不良反应，提高满意度。

[关键词] 机械通气;PICU;适度镇静;护理干预;效果;体会

[中图分类号] R446.5          [文献标识码] B          [文章编号] 1673-9701（2021）32-0173-04

[Abstract] Objective To investigate the application effect of comfortable nursing in the moderate sedation and analgesia for PICU children with mechanical ventilation. Methods A total of 48 children who underwent mechanical ventilation treatment in our hospital from January 2019 to October 2020 were selected and divided into the control group and the observation group， with 24 cases in each group according to a random number table. Children in both groups were given midazolam and fentanyl for sedation and analgesia treatment. The control group received routine sedation and analgesia care， and the observation group received comfortable nursing intervention. The onset time of sedation and analgesia， mechanical ventilation time， time to recovery from drug withdrawal and adverse reactions were recorded， and the degree of sedation was evaluated according to the RASS scale. Nursing satisfaction of Children was compared between the two groups. Results The onset time of sedation and analgesia， mechanical ventilation time， time to recovery from drug withdrawal and RASS score in the observation group were better than those in the control group（P<0.05）. The adverse reactions after sedation and analgesia treatment were mainly respiratory depression， bradycardia， nausea， hypotension， etc. The total incidence of adverse reactions of children in the observation group was 12.50%， significantly lower than that of 33.33% in the control group （P<0.05）. The overall satisfaction rate of children in the observation group was 95.84%， significantly higher than that of 70.83% in the control group（P<0.05）. Conclusion The combination of sedative and analgesic drugs with comfortable nursing intervention in pediatric mechanical ventilation can improve heart rate， blood pressure breath and SpO2， reduce mechanical ventilation time and adverse drug reactions， improve satisfaction.

[Key words] Mechanical ventilation; PICU; Moderate sedation; Nursing intervention; Effect; Experience

机械通气能够有效维持小儿动脉血气基本要求，在机械通气的过程中需要对患儿进行适度镇静镇痛能够防止通气过程中发生躁动引发非计划拔管情况[1]。为了降低机械通气导致的相关性肺炎的并发症，需要给予镇静镇痛药物，联合应用舒适护理，提高患儿的满意度和依从性。……