吴畏 杨飞云 牛丽丹 陈希妍 张江波

【摘要】 目的 探討每日唤醒与舒适化镇痛镇静两种方案在急诊重症监护室（EICU）机械通气患者中的应用价值。

方法 选取2018年1月至2019年1月医院收治的机械通气患者100例，按随机数字表分为对照组和观察组，每组50例。对照组采用每日唤醒镇痛镇静方法，观察组采用舒适化镇痛镇静方法。比较两组患者呼吸机使用时间、住院时间、VAP和谵妄发生率、镇静药物用量等指标。

结果 观察组呼吸机使用时间（5.3±1.8）天，低于对照组的（8.4±2.6）天，差异有统计学意义（t=6.932，P<0.001）;观察组EICU住院时间（6.9±2.1）天，低于对照组的（10.6±2.9）天，差异有统计学意义（t=7.307，P<0.001）。观察组VAP发生率为16.0%，低于对照组的38.0%，差异有统计学意义（χ2=6.139，P<0.05）;观察组谵妄发生率为18.0%，低于对照组的36.0%，差异有统计学意义（χ2=4.110，P<0.05）。观察组右美托咪定日均用量为（694.8±274.6） μg，低于对照组，差异有统计学意义（t=4.450，P<0.001）;观察组右美托咪定总用量为（5915.7±2319.7） μg，低于对照组，差异有统计学意义（t=5.903，P<0.001）。

结论 在EICU机械通气患者中使用舒适化镇痛镇静方法，可以减少镇静药物使用量和降低不良事件发生，还可以缩短患者住院时间和机械通气时间。

【关键词】 每日唤醒;机械通气;舒适化镇痛镇静;EICU

中图分类号：R459.7   文献标志码：A   DOI：10.3969/j.issn.1003-1383.2021.04.010

Comparison of daily awakening and comfortable analgesia and sedation in patients with mechanical ventilation in EICU

WU Wei， YANG Feiyun， NIU Lidan， CHEN Xiyan， ZHANG Jiangbo

（Emergency Department， The First Affiliated Hospital of Xinxiang Medical College， Xinxiang 453100， Henan， China）

【Abstract】 Objective To explore the application value of daily awakening and comfort analgesia and sedation in patients with mechanical ventilation in emergency intensive care unit（EICU）.

Methods 100 patients with mechanical ventilation who admitted to hospital from January 2018 to January 2019 were randomly divided into control group and observation group， with 50 cases in each group. The control group were given daily awakening analgesia and sedation， and the observation group were given comfort analgesia and sedation. And then， the duration of ventilator use， length of hospital stay， incidence of VAP and delirium， dosage of sedative drugs and other indicators were compared between the two groups.

Results The time of ventilator use in the observation group was （5.3 ± 1.8） days， which was lower than that of the control group （[8.4 ± 2.6] days）， and difference was statistically significant（t = 6.932， P < 0.001）. The length of hospital stay of EICU in the observation group was （6.9 ± 2.1） days， which was lower than that of the control group （[10.6 ± 2.9] days）， and difference was statistically significant （t = 7.307， P < 0.001）. The incidence of VAP in the observation group was 16.0%， which was lower than that of the control group（38.0%）， and difference was statistically significant（χ2=6.139， P < 0.05）. The incidence of delirium in the observation group was 18.0%， which was lower than that in the control group（36.0%）， and difference was statistically significant（χ2=4.110， P < 0.05）. The average daily dose of dexmedetomidine in the observation group was （694.8 ± 274.6） μg， which was lower than that of the control group， and difference was statistically significant （t = 4.450， P < 0.001）. The total dosage of dexmedetomidine in the observation group was （5915.7 ± 2319.7） μg， which was lower than that of the control group， and difference was statistically significant （t = 5.903， P < 0.001）.

Conclusion Comfort analgesia and sedation can not only reduce the use of sedative drugs and the incidence of adverse events， but also shorten hospitalization time and mechanical ventilation time of patients with mechanical ventilation in EICU.

【Key words】 daily awakening; mechanical ventilation; comfort analgesia and sedation; EICU

急诊重症监护室（emergency intensive care unit，EICU）机械通气患者，因疾病、疼痛以及各类管道通道束缚等，患者常有焦虑躁动情绪，若不予管理，可影响患者康复。镇痛镇静治疗为EICU常规治疗，可以消除患者不良情绪和不适，适当的镇痛镇静可以保证治疗的高效，保护患者脏器组织功能，改善患者预后;而不恰当的镇痛镇静可加重患者病情，造成循环功能波动，最后延长患者住院治疗时间，延迟患者康复进程[1]。舒适化镇痛镇静方法是以病人为中心的治疗方法，强调尽早干预促进患者的舒适程度，优先镇痛和最小镇静，以及对患者实施人文关怀[2]。目前，尚未见文献报道两者在EICU机械通气患者中的应用对比，为此，本研究选取我院EICU于2018年1月至2019年1月收治的机械通气患者100例，通过探讨每日唤醒与舒适化镇痛镇静两种方案在EICU机械通气患者中的应用，旨在为临床提供参考。……