ABCDE集束化镇痛镇静策略在ICU机械通气患者中应用效果的Meta分析

目的系统评估ABCDE集束化镇痛镇静策略在ICU机械通气患者中的应用效果。方法计算机检索中国期刊全文数据库、万方数据库、中国生物医学文献服务系统、Cochrane图书馆、MEDLINE、Web of SCIENCE、EMbase中关于ABCDE集束化镇痛镇静策略的RCT文献,采用RevMan5.2软件进行统计处理。结果共纳入3篇中文RCT文献,Meta分析结果显示:集束化干预策略能够缩短ICU患者的机械通气时间(Z=7.13,P0.01)、ICU治疗时间(Z=6.85,P0.01),降低谵妄的发生率(Z=4.40,P0.01)。结论 ABCDE集束化镇痛镇静策略对ICU机械通气患者是安全有效的,建议应用于每日的治疗护理中。     

苯磺酸瑞马唑仑用于ICU机械通气患者镇静的有效性与安全性

目的探讨苯磺酸瑞马唑仑对ICU机械通气患者镇静的有效性及对呼吸循环系统的影响。 方法采用前瞻性随机对照研究方法,选择2021年1月至9月信阳市中心医院综合ICU收治的有镇静需求的机械通气患者92例,将其随机分为2组,苯磺酸瑞马唑仑组（R组）45例,丙泊酚组（P组）47例。2组患者分别给予舒芬太尼镇痛,维持镇痛目标为重症监护疼痛观察工具（CPOT）评分＜2分。其中R组给予苯磺酸瑞马唑仑7 mg负荷剂量及2.5 mg追加剂量（达不到目标镇静深度时）静脉推注,再以0.1~0.5 mg/（kg·h）静脉泵入维持镇静;P组对于年龄＜55岁的患者给予丙泊酚0.5~1.5 mg/kg负荷剂量静脉推注（年龄＞55岁患者酌情减量）,再以0.1~1 mg/（kg·h）静脉泵入维持镇静。根据Richmond镇静-躁动（RASS）评分标准,维持2组患者的目标镇静深度为-2~-3分。比较2组患者药物起效时间、停药后苏醒时间、用药前（T0）及用药后1 h（T1）、6 h（T6）、12 h（T12）、24 h（T24）时间点的心率（HR）、收缩压（SBP）、舒张压（DBP）、左室射血分数（LVEF）、左室流出道速度-时间积分（VTI）、呼吸频率（RR）、脉搏血氧饱和度（SpO₂）的变化。 结果2组患者性别、年龄、身高、体质量、急性生理学与慢性健康状况评分Ⅱ（APACHE Ⅱ）等基线资料、用药前呼吸及血流动力学指标等比较,差异均无统计学意义（P＞0.05）。给药后R组和P组起效时间比较,差异无统计学意义［（85.7±18.6）s vs（94.7±32.6）s,P=0.108］;停药后R组比P组苏醒时间更短,差异有统计意义［（22.6±6.25）s vs（25.9±7.9）s,P=0.028］;组内比较,相比于T0时间点,T1、T6、T12、T24时2组的HR、SBP、DBP、RR、LVEF、VTI均有下降,而SpO₂上升,差异均有统计学意义（P＜0.01）;组间比较,2组患者用药后HR_{（T1、T6、T24）}、SBP_{（T1、T6、T12、T24）}、DBP_{（T1、T6、T12）}、LVEF_{（T1、T6、T24）、}VTI_{（T1、T6、T24）}比较,差异均有统计学意义（P＜0.05）,而RR_{（T1、T6、T12、T24）}、SpO_{2（T1、T6、T12、T24）}比较,差异无统计学意义（P＞0.05）。 结论苯磺酸瑞马唑仑、丙泊酚都具有起效快的优点。相比于丙泊酚,苯磺酸瑞马唑仑苏醒快且对于心率、血压、心脏收缩功能影响更小,更适合于ICU患者的镇静治疗。     

每日唤醒应用于机械通气镇静患儿的研究进展

每日唤醒指在连续性使用镇静药物的过程中,每日进行短时间的停用镇静药物,待患者逐渐清醒,能够根据指示做出相对应动作后再重新给予镇静治疗。该文介绍了每日唤醒的起源与发展,阐述了每日唤醒的实施者、实施对象、干预方式、评估工具,分析并探讨了每日唤醒在机械通气镇静患儿中的应用效果,并提出相关建议,以期为我国开展相关实践提供借鉴与参考。     

对镇静治疗机械通气患者行BIS监测的护理现状

镇静治疗是ICU机械通气患者的基本治疗之一,合适的镇静水平有助患者身心的康复.脑电双频指数,作为一种客观评估镇静深度的手段,已逐步运用到ICU机械通气患者.对脑电双频指数原理、方法及患者在行机械通气镇静治疗时的护理现状作一综述.     

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.     

ICU机械通气患者应用镇静治疗的安全护理分析

目的探讨ICU机械通气患者应用镇静治疗的安全护理效果。方法选取我院ICU 2013年1月~12月进行机械通气的患者100例作为研究对象,随机分为对照组和实验组,各50例。对照组采用地西泮注射液和鲁米那注射液进行镇静。实验组采用咪达唑仑注射液和丙泊酚注射液进行镇静。观察两组不良反应发生率及治疗满意率,并进行比较。结果实验组不良反应发生率(8%)明显低于对照组(32%),实验组治疗总满意率(94%)明显高于对照组(62%),两组比较有显著性差异(P0.05)。结论咪达唑仑、丙泊酚注射液镇静效果优于地西泮、鲁米那注射液,有效减少人机对抗,减少非计划性拔管的发生,保证患者安全,增加患者及家属的满意度。     

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。     

Effects of nurse-led sedation protocols on mechanically ventilated intensive care adults: A systematic review and meta-analysis

ObjectivesThe objective of the study was to compare nurse-led sedation protocols with physician-led usual care in intensive care units (ICUs) in treating mechanically ventilated adult patients.Review method usedThis is a systematic review and meta-analysis.Data sourcesPubMed, Cochrane Library, EMBASE, CINAHL, China National Knowledge Infrastructure, and China Wanfang databases were interrogated for articles published before May 2020.Review methodAs per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, eight randomised controlled trials (RCTs) and six preintervention and postintervention studies published in English and Chinese met the inclusion criteria for the meta-analysis. Two reviewers independently extracted data into a tabular format using predefined data fields. Disagreements were resolved by consensus. The quality of the included RCTs and preintervention and postintervention studies was assessed using the Cochrane Quality Assessment Tool and Risk Of Bias In Non-randomised Studies of Interventions assessment tool.ResultsEight RCTs were of intermediate methodological quality, and six preintervention and postintervention studies exhibited a low to moderate risk of bias. Compared with usual care, nurse-led sedation protocols resulted in significantly decreased durations of mechanical ventilation (days) (standardised mean difference = ?1.765; 95% confidence interval [CI] = ?2.461, ?1.068); P < 0.001; I² = 97.7%); decreased length of ICU stay (days) (standardised mean difference = ?1.463; 95% CI = -2.181, ?0.745; P < 0.001; I² = 97.3%); reduced ICU mortality (relative risk [RR] = 0.854; 95% CI = 0.747, 0.983; P = 0.027), I² = 0%); and decreased incidence of ventilator-associated pneumonia (RR = 0.438; 95% CI = 0.292, 0.657; P < 0.001; I² = 41.4%), delirium (RR = 0.522; 95% CI = 0.338, 0.807; P = 0.003; I² = 26.6%), and extubation failure (RR = 0.498; 95% CI = 0.266, 0.932; P = 0.029; I² = 45.1%).ConclusionsAlthough pre–post intervention study design cannot establish causality, the present findings raise the considerable possibility that a sedation protocol can be safely implemented by nurses to reduce mortality in ICUs and sedation-related adverse events in patients on mechanical ventilation compared with physician-led usual care.     

应用右美托咪定及丙泊酚在重症肺炎使用有创机械通气患者中的镇静疗效研究

目的比较右美托咪定及丙泊酚应用于重症肺炎有创机械通气患者的镇静效果及安全性。 方法前瞻性分析2015年1月至2017年12月江苏大学附属人民医院重症监护治疗病房（ICU）收治的重症肺炎有创机械通气患者100例,将患者随机分为右美托咪定镇静组（50例）及丙泊酚镇静组（50例）。对两组患者均给予抗感染、有创机械通气、集束化治疗,并予瑞芬太尼镇痛。在镇痛基础上,对两组患者分别给予右美托咪定和丙泊酚镇静治疗。维持患者Richmond躁动-镇静量表评分在-2~0分之间。对于右美托咪定组和丙泊酚组两组患者年龄、APACHEⅡ评分、临床肺部感染评分（CPIS）、机械通气时间、拔管时间、住ICU时间,以及应用镇静药物前和应用镇静药物15 min后平均动脉压（MAP）、心率（HR）、呼吸频率（RR）等资料,其中应用镇静药物前后资料的比较采用配对样本t检验,组间资料的比较采用两组独立样本t检验。对于两组患者的性别分布,谵妄、VAP发生情况以及30 d内死亡情况的比较采用χ²检验。 结果右美托咪定组和丙泊酚组两组患者在性别、年龄、APACHEⅡ评分、CPIS方面相比较,差异无统计学意义（P均>0.05）。两组患者应用镇静药物前的MAP、HR、RR差异无统计学意义（P均>0.05）。与用药前比较,应用镇静药物15 min后两组患者的MAP、HR、RR均下降,差异具有统计学意义（P均<0.01）。与右美托咪定组比较,应用镇静药物15 min后丙泊酚组患者MAP、RR下降更为显著,差异具有统计学意义（P均<0.05）。右美托咪定组患者与丙泊酚组比较,应用镇静药物15 min后HR下降更为显著,差异具有统计学意义（P<0.05）。与丙泊酚组比较,右美托咪定组的机械通气时间、拔管时间及住ICU时间均减少,差异具有统计学意义（P均<0.05）。与丙泊酚组比较,右美托咪定组患者谵妄发生率较低,差异具有统计学意义（P<0.05)。两组患者VAP发生率及30 d病死率差异无统计学意义（P均>0.05）。 结论将右美托咪定应用于重症肺炎有创机械通气患者,可减少机械通气时间及住ICU时间,谵妄的发生率低于丙泊酚治疗组。     

Perceived barriers to the use of sedation protocols and daily sedation interruption: A multidisciplinary survey

Background

Although use of sedation protocols and daily sedation interruption (DSI) improve outcome, their current use and barriers affecting their use are unclear.

Methods

We designed a multidisciplinary, Web-based survey to determine current use of sedation protocols and DSI and the perceived barriers to each, and administered it to members of the Society of Critical Care Medicine.

Results

The 904 responders were physicians (60%), nurses (14%), or pharmacists (12%); 45% worked in a university hospital. Of 64% having a sedation protocol, 78% used it for ≥50% of ventilated patients. Reasons for lack of protocol use included no physician order (35%), lack of nursing support (11%), and a fear of oversedation (7%). Daily sedation interruption was used by only 40%. Barriers to DSI included lack of nursing acceptance (22%), concern about risk of patient-initiated device removal (19%), and inducement of either respiratory compromise (26%) or patient discomfort (13%). Clinicians who prefer propofol were more likely to use DSI than those who prefer benzodiazepines (55% vs 40, P < .0001).

Conclusions

Current intensive care unit sedation practices are heterogeneous, and the barriers preventing the use of both sedation protocols and DSI are numerous. These barriers should be addressed on an institutional basis to boost the use of these evidence-based practices.     

基于eCASH理念的镇静镇痛护理对ICU机械通气谵妄的预防效果

目的 研究基于eCASH(以患者为中心的舒适化浅镇静策略)理念的镇静镇痛护理对ICU机械通气谵妄的预防效果。方法 将2016年1月至2018年12月昆山市第三人民医院ICU收治的机械通气患者104例依据随机数表法分为对照组和观察组，每组52例。对照组进行常规镇静镇痛护理，观察组在常规护理基础上加入基于eCASH理念的镇静镇痛护理。对比两组患者ICU住院时间、机械通气时间、呼吸功能及谵妄发生情况。结果 观察组患者住ICU时长与机械通气时长均低于对照组(P＜0.05)；观察组患者的第一种时间肺活量、呼气流速峰值、肺活量、肺总量及潮气量均高于对照组(P＜0.05)；观察组的谵妄、转科、死亡/放弃治疗发生率均低于对照组(P＜0.05)。结论 eCASH理念护理模式强调以患者及其家属为中心，采用最小化镇静及优先镇痛，让患者充分感受到更加人性化的护理，降低了ICU机械通气患者的谵妄发生率，且缩短了患者的恢复时间，促进疾病转归。     

脑电双频指数与镇静-躁动评分指导短期机械通气患者镇静治疗的随机对照研究

目的 比较脑电双频指数(BIS)实时监测和镇静-躁动评分(SAS)在重症监护病房(ICU)短期机械通气患者镇静治疗实施过程中的可行性.方法 选择ICU中18～60岁外科手术后需持续机械通气(＞12 h)患者105例,按信封法随机分为BIS组(42例)和SAS组(63例),分别依据BIS和SAS评估镇静深度.两组均给予芬太尼镇痛,丙泊酚和咪唑安定联合镇静,每小时根据镇静深度评估调节镇静药物泵入剂量(BIS组目标值为50～70,SAS组目标为3～4级).入ICU后次日晨6时停用镇静及镇痛药物,每小时记录镇静深度(BIS值或SAS分级)、镇静持续时间、觉醒时间、机械通气时间、单位时间内咪唑安定和丙泊酚用量及累计总量,以及吸痰后躁动发生率、镇静期间气管导管耐受率和疼痛耐受率、拔管后谵妄发生率.结果 BIS组单位时间内眯唑安定和丙泊酚用量均高于SAS组[咪唑安定(mg·kg-1·h-1):0.10±0.02比0.09±0.02,丙泊酚(mg·kg-1·h-1):0.95±0.23比0.86±0.20,均P＜0.05],总体镇静达标时段(Dt,以1 h为1个时段)以及前3个时段(D1、D2、D3)的镇静达标率均明显高于SAS组[Dt:75.2%(507)比52.8%(421),D1:78.6%(33)比22.2%(14),D2:88.1%(37)比20.6%(13),D3:81.0%(34)比31.7%(20),均P＜0.01],觉醒时间(min)明显短于SAS组[0(0,20)比15(0,47),P＜0.05];BIS组和SAS组患者急性生理学与慢性健康状况评分系统Ⅱ(APACHE Ⅱ)评分(分:3.57±2.60比4.19±2.30)、机械通气时间[h:16.5(14.5,19.0)比17.0(15.0,19.0)]、镇静持续时间[h:14.0(12.9,17.1)比16.0(13.0,18.0)]及吸痰后躁动发生率(81.0%比79.4%)、镇静期间气管导管耐受率(71.4%比74.6%)和疼痛耐受率(92.8%比93.6%)、拔管后谵妄发生率(4.8%比1.6%)等差异均无统计学意义(均P＞0.05).结论 与SAS比较,BIS在指导ICU短期机械通气患者的镇静治疗中,对镇静深度调控具有更好的可操作性.

Abstract：

Objective To compare the value of bispectral index (BIS) monitoring and sedationagitation scale (SAS) in guiding intensive care unit (ICU) sedation therapy for the patients undergoing shortterm mechanical ventilation. Methods One hundred and five patients aged 18 - 60 years after operation receiving mechanical ventilation for longer than 12 hours in ICU were enrolled in this study. The patients were randomly divided into two groups: BIS-guided group (n=42) and SAS-guided group (n=63). All of them received protocolized continuous sedation and analgesia by using fentanyl for analgesia and propofol plus midazolam to sedate intravenously. The effect of sedation was assessed every hour till BIS reaching 50 - 70 or SAS reaching grade 3 - 4. Sedatives and analgesics were suspended st 6: 00 am on next day after ICU admission, and BIS and the SAS were recorded every hour, sedation time, time to wake up, duration of mechanical ventilation, daily dosage of midazolam and propoful, and the incidence of adverse events including restlessness after suction, endotracheal tube resistance, pain tolerance during sedation, and delirium after extubation were all recorded accordingly. Results Dosages of midazolam and propofol were found higher in BIS-guided group than the SAS-guided group [midazolam (mg · kg-1 · h-1) : 0. 10±0. 02 vs. 0. 09±0. 02,propofol (mg · kg-1 · h-1): 0. 95±0. 23 vs. 0. 86±0. 20, both P＜0.05＝. The total time (Dt) of patients under sedative control was significantly longer in BIS-guided group compared with SAS-guided group, and also in first three hours [D1, D2, D3, D,: 75.2% (507) vs. 52.8% (421), D1: 78.6% (33) vs. 22.2%(14), D2: 88. 1% (37) vs. 20. 6% (13), D3: 81.0% (34) vs. 31.7% (20), all P＜0. 01＝. The time to wake up (minutes) was significantly shorter in BIS-guided group compared with SAS-guided group [0 (0, 20) vs.15 (0, 47), P＜0.05＝. No significant difference in acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ ) score (3. 57± 2. 60 vs. 4. 19 ± 2. 30), duration of mechanical ventilation [hours: 16. 5 (14.5, 19.0) vs. 17.0 (15.0, 19.0)], sedation time [hours: 14.0 (12.9, 17.1) vs. 16.0 (13.0, 18.0)]and incidence of adverse events including restlessness after suction (81.0% vs. 79. 4%), endotracheal tube resistance (71.4% vs. 74.6%), pain tolerance during sedation (92.8% vs. 93.6%) and delirium after extubation (4. 8% vs. 1.6%) was found between BIS-guided group and SAS-guided group (all P＞0. 05).Conclusion BIS monitoring is better in sedative control than SAS assessment for ICU patients undergoing short-term mechanical ventilation.     

A systematic review and critical appraisal of guidelines and their recommendations for sedation interruptions in adult mechanically ventilated patients

ObjectiveThe objectives of the review were to (i) assess the methodological quality of all accessible and published guidelines and care bundles that offer a recommendation related to sedation interruptions, using the AGREE-II instrument, to (ii) determine what is the recommended best practice for sedation interruptions from the available guidelines, and then to have (iii) a closer inspection of the overall credibility and applicability of the recommendations using the AGREE-REX instrument. This review will benefit the outcomes of critically ill patients and the multidisciplinary team responsible for the care of mechanically ventilated adults with continuous medication infusions by providing a synthesis of the recommended action(s), actor(s), contextual information, target(s), and timing related to sedation interruptions from current best practice.Review method usedWe conducted a systematic review.Data sourcesWe applied a peer-reviewed search strategy to four electronic databases from 2010 to November 2021—MEDLINE, CINAHL, Embase, and The Cochrane Database of Systematic Reviews—and included grey literature.Review methodFindings are reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses checklist. We assessed overall quality using the validated Appraisal of Guidelines for Research and Evaluation II and AGREE Recommendation Excellence tools.ResultsWe identified 11 clinical practice guidelines and care bundles comprising 15 recommendations related to sedation interruption. There are three key findings: (i) deficiencies exist with the methodological quality of included guidelines, (ii) sedation interruption is recommended practice for the care of adult mechanically ventilated patients, and (iii) the current evidence is of low quality, which impacts overall credibility and applicability of the recommendations.ConclusionsSedation interruptions are currently best practice for adult mechanically ventilated patients; however, the available guidelines and recommendations have several deficiencies. Future research is needed to further understand the role of the nurse and other actors to enact this practice.     

Conscious sedation in the critically ill ventilated patient

Purpose

The aim of sedation is to provide comfort and minimize anxiety. However, adverse effects are noteworthy, and the optimal end point of sedation in intensive care unit patients is still debated. We analyzed if a level 2 on the Ramsay Scale (ie, awake, cooperative, oriented, tranquil patient) is suitable for an invasive therapeutic approach.

Materials and Methods

Forty-two patients requiring respiratory support and sedation for at least 4 days were enrolled in a prospective interventional cohort study aiming at maintaining patients awake and collaborative. The Ramsay score was recorded 3 times a day. Once a day, the nurse in charge evaluated adequacy of sedation according to the compliance with nursing care and therapeutic maneuvers in the previous 24 hours. Data were collected until patients were ventilated.

Results

Overall, 264 of 582 days were classified as conscious. Sedation was adequate in 93.9% of them. In conscious days, a higher Simplified Acute Physiology Score II score and male sex significantly correlated with inadequate sedation.

Conclusions

In a population of severe intensive care unit patients, conscious sedation was achieved in almost half of the days spent on ventilation. The positive implications (eg, on length of weaning and cost of sedation) of a conservative sedation strategy may be highly relevant.     

Dexmedetomidine versus propofol/midazolam for long-term sedation during mechanical ventilation

Purpose  To compare dexmedetomidine (DEX) with standard care (SC, either propofol or midazolam) for long-term sedation in terms of maintaining target sedation and length of intensive care unit (ICU) stay. Methods  A pilot, phase III, double-blind multicenter study in randomized medical and surgical patients (n = 85) within the first 72 h of ICU stay with an expected ICU stay of ≥48 h and sedation need for ≥24 h after randomization. Patients were assigned to either DEX (≤1.4 μg kg⁻¹ h⁻¹; n = 41) or SC (n = 44), with daily sedation stops. Results  Non-inferiority of DEX versus SC was not confirmed. Target Richmond agitation–sedation score (RASS) was reached a median of 64% (DEX) and 63% (SC) of the sedation time (ns). The length of ICU stay was similar in DEX and SC. Patients with RASS target 0–3 (DEX 78%, SC 80%) were at target sedation 74% (DEX) and 64% (SC) of the time (ns), whereas those with RASS target −4 or less reached the target 42% (DEX) and 62% (SC) of the time (P = .006). Post hoc analyses suggested shorter duration of mechanical ventilation for DEX (P = 0.025). Conclusions  This pilot study suggests that in long-term sedation, DEX is comparable to SC in maintaining sedation targets of RASS 0 to −3 but not suitable for deep sedation (RASS −4 or less). DEX had no effect on length of ICU stay. Its effects on other relevant clinical outcomes, such as duration of mechanical ventilation, should be tested further. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users. Registered at ClinicalTrials.gov, number NCT00226785. A complete list of investigators and study centers appears in the Appendix. This study was sponsored by Orion Pharma, Helsinki, Finland, through research contracts negotiated directly with the participating hospitals.     

机械通气患者镇静早期深镇静发生情况及危险因素分析

目的 分析ICU机械通气镇静患者早期深镇静的发生情况及危险因素,为降低深镇静的发生率提供参考依据.方法 采用回顾性研究方法选取ICU机械通气镇静患者77例,分析早期深镇静的发生情况及相关危险因素.结果 机械通气早期有57.14％ 的患者发生了深镇静;二元Logistic回归分析显示:使用苯二氮卓类药物(OR:6.685...     

基于eCASH理念的最小化镇静策略联合早期目标导向活动在ICU机械通气患者中的应用

目的:分析基于eCASH理念的最小化镇静策略联合早期目标导向活动在ICU机械通气患者中的应用效果.方法:选择2019年1月—12月期间入院的56例ICU机械通气患者,随机分为干预组与对照组.给予对照组患者镇痛、镇静及ICU常规肢体活动护理,干预组患者实施基于eCASH理念的最小化镇静策略联合早期目标导向活动护理方案.比...     

注药式气管导管在术后ICU病人机械通气中的应用

目的 采用注药式气管导管对术后机械通气的ICU病人行气道表面麻醉，观察机械通气过程中病人对气管导管的耐受情况。方法 选择34例胸腹部手术、术后行机械通气12h以上的病人，随机分为两组，每组17例。对照组（C组）：经注药式气管导管气管内注射生理盐水；治疗组（T组）：经注药式气管导管气管内注射2％利多卡因。观察病人在机械通气12h内气管导管的耐受情况和镇静药物咪唑安定、芬太尼的给药次数及使用量的变化。结果 治疗组病人在机械通气12h内呛咳反应、高血压和心动过速的发生次数显著低于对照组（P〈0．05）；治疗组病人在机械通气12h内咪唑安定和芬太尼给药次数和使用量显著低于对照组（P〈0．05）。结论 使用注药式气管导管进行气道表面麻醉可以显著减轻气管导管引起的不适反应，减少ICU病人的镇静药物用量。     

吗啡-咪达唑仑与普鲁泊福、咪达唑仑在机械通气患者镇静中的成本-效果分析

目的 评价吗啡-咪达唑仑与普鲁泊福、咪达唑仑在机械通气患者镇静中的疗效及成本-效果.方法 93例需要机械通气患者随机分为3组:普鲁泊福组:首剂1 mg/kg,维持剂量1 mg/(kg·h).吗啡-咪达唑仑组:吗啡首剂0.05 mg/kg,维持剂量0.05 ms/(kg·h);咪达唑仑首剂0.15 mg/kg,维持剂量0.05 mg/(kg·h).咪达唑仑组:首剂0.15 mg/kg,维持剂量0.05 mg/(kg·h).根据Ramsay镇静评分逐渐增加镇静药物剂量.记录镇静时间、停药至拔管时间、镇静费用及低血压发生率.结果 咪达唑仑组停镇静药至拔管时间为(6.0±2.4)h,长于普鲁泊福组的(4.6±1.7)h(P<0.01).吗啡-咪达唑仑停镇静药至拔管时间(5.6±2.7)h与普鲁泊福组(4.6±1.7)h差异无统计学意义(P>0.05).吗啡-咪达唑仑组镇静费用(101.7±20.4)元低于咪达唑仑组(127.7±21.3)元(P<0.05)及普鲁泊福组(199.7±65.9)元(P<0.01),咪达唑仑组及吗啡-咪达唑仑组低血压发生率低于普鲁泊福组[分别为3.2%(1/31)、9.7%(3/31)、35.4%(11/31),P<0.05,P<0.01].结论 吗啡-咪达唑仑在机械通气患者镇静中较普鲁泊福及咪达唑仑更安全、经济,值得临床推广使用.     

被动抬腿试验预测呼吸机脱机结局：一项系统综述和荟萃分析

目的评估被动抬腿试验（PLR）对呼吸机脱机结局的预测能力。 方法以关键词"被动抬腿试验"、"机械通气"、"脱机"在中国知网、维普网、百度学术、中国临床试验注册中心搜索文献及相关临床研究,以关键词"passive leg raising or raise"、"mechanical ventilation or ventilator"、"weaning"在PubMed、Embase、the Cochrane Library、clinicaltrials.gov上搜索文献及相关临床研究;搜索日期为建库至2018年2月11日。文献搜索和数据提取由两人独立进行,所获文献采用诊断准确性研究的质量评价工具（QUADAS-2）评估其研究质量,相关数据则使用RevMan 5.3.5和Meta-disc软件进行分析。 结果最终有3篇文献被纳入,其中中文1篇,英文2篇,均具有较高的质量评分。患者总数为145人,共进行228例次PLR和脱机试验。其中,PLR阳性123例次,脱机成功87例次,失败36例次;PLR阴性105例次,脱机成功18例次,失败87例次。PLR预测脱机的正确率为76%。PLR阳性预测脱机成功的敏感度为0.83（95%CI：0.74~0.90）,特异度为0.71（95%CI：0.62~0.79）;汇总受试者操作特征曲线（SROC）曲线下面积为0.82±0.04,约登指数为0.54。 结论被动抬腿试验能用于预测呼吸机脱机结局。