集束干预策略应用于机械通气镇痛镇静患者的效果评价

目的评价机械通气(mechanical ventilation,MV)患者在镇痛镇静治疗期间应用集束干预策略的效果。方法按入科顺序编号将2011年1～10月ICU收治的108例MV患者分为2组,单号为干预组(n=57),在常规镇痛镇静护理的同时,应用集束干预策略,包括每日镇静中的唤醒、呼吸同步、镇静和镇痛药物的选择或应用、谵妄的监测和处理、早期运动和锻炼。双号为对照组(n=51),采用常规镇痛镇静护理,以及意识水平、镇痛镇静程度及脏器功能的评估监测等;比较两组患者的镇痛镇静药物使用剂量、机械通气时间、ICU治疗时间、总住院日、谵妄发生率及28d生存率。结果干预组患者镇痛镇静药物的使用剂量、机械通气时间、ICU治疗时间、总住院日与对照组相比,差异有统计学意义(P<0.001);干预组谵妄发生率低于对照组,差异有统计学意义(P<0.05)。结论集束干预策略较常规镇痛镇静护理能使MV患者取得较好的临床效果。

Effect of ABCDE bundle in mechanically ventilated patients treated with sedatives and analgesics

Objective To evaluate the effect of ABCDE bundle in mechanically ventilated patients treated with sedatives and analgesics with mechanical ventilation.Methods One hundred and eight patients with mechanical ventilation who were admitted in ICU from January to October 2011 were divided into two groups.The patients in the control group(n=51) received routine nursing care.The patients in the experimental group(n=57) received the ABCDE bundle nursing,including awakening the patient daily(A),breathing(B),choice of sedative or analgesic drugs(C),delirium monitoring and management(D),and early exercise(E).The doses of sedatives and analgesics,the durations of mechanical ventilation,ICU stay and hospital stay,the incidence of delirium and 28-day hospital survival were compared between the two groups.Results The dose of analgesic,the durations of mechanical ventilation,ICU stay,hospital stay and the incidence of delirium in the experimental group were significantly lower than those of the control group(P<0.05 or P<0.001).Conclusion The ABCDE bundle is better than routine nursing care in patients with mechanical ventilation.