RICU机械通气患者的镇静治疗方法的探讨

目的 探讨呼吸重症监护病房(RICU)机械通气患者合理镇静治疗方案.方法 选择2010年2月-2011年8月RICU收治的重症呼吸衰竭、神志清醒、需气管插管机械通气＞24 h的患者80例,按随机数字表随机分为A、B、C、D4个组,每组20例,对B组和D组患者的BIS值进行比较分析,同时比较分析4组患者插管用药前即刻和插管后1h的平均无创动脉血压和心率.结果 所有患者的Ramsay评分维持在3～4分,B组患者用药前脑电双频指数(BIS)值为97.25±1.28、D组患者用药前BIS值为98.08±1.06,二者比较差异无统计学意义,插管后BIS值均有所下降,插管后1hB组患者BIS值为64.33±3.14、D组患者为62.23±2.39,与插管用药前比较差异有统计学意义(P＜0.05),在不同时间段,B组和D组插管后BIS值比较差异无统计学意义,4组患者用药前平均血压和心率比较差异无统计学意义,插管后平均血压和心率均有所下降,与插管即刻比较差异有统计学意义(P＜0.05).结论 对于呼吸重症监护病房呼吸机辅助呼吸患者的镇静治疗是十分必要的,但对不同患者要选择适当的评价标准,并要密切观察患者的生命体征变化,随时调整治疗方案,以达到提高患者生活质量的目的.

Sedation and analgesia of patients undergoing mechanical ventilation in respiratory intensive care unit

OBJECTIVE To explore the sedation and analgesia treatment of mechanically ventilated patients in respiratory intensive care unit.METHODS A total of 80 patients admitted to RICU from Fed.2010 to Aug.2011 with severe respiratory failure,consciousness,need for intubation and mechanical ventilation more than 24h were selected and randomly divided into four groups,groups A,B,C and D,with 20 cases each.BIS values of patients in Group B and Group D were compared.Comparative analysis of mean non-invasive arterial pressure and heart rate of patients in 4 groups immediately before intubation administration and 1h after intubation was performed.RESULTS All patients with Ramsay score remained at 3-4.BIS value of Group B patients immediately before intubation was(97.25±1.28) and BIS value of group D patients immediately before intubation was(98.08±1.06).There was no statistical difference between the two groups.After intubation,BIS values were decreased,BIS value of group B patients 1h after intubation was(64.33±3.14) and BIS value of group D patients 1h after intubation was(62.23±2.39).Compared with those immediately before intubation,there was significant difference(P<0.05).In different periods,group B and group D after intubation showed no statistical difference in BIS value.In addition,the average blood pressure and heart rate of the patients in four groups before using drug showed no significant difference.The mean blood pressure and the heart rate after intubation were decreased.Compared with those immediately before intubation,there were statistical differences(P<0.05).CONCLUSION Analgesia and sedation are necessary for the mechanical ventilation patients in respiratory intensive care unit,but we should select the appropriate evaluation criteria for different patients,closely observe the changes of patients’ vital signs,adjust treatment regimen at any time to meet the purpose of improving patients’ life quality.