每日唤醒频率对机械通气镇静患者应激影响的临床研究

被引：0

作者：

彭光明

机构：

[1] 昆明医学院

关键词：

每日唤醒; 脑电双频指数; 闭环靶控输注; 镇静; 应激;

D O I：

暂无

年度学位：

2010

学位类型：

硕士

导师：

钱传云; 许汪斌; 吴海鹰;

摘要：

目的：评估每日唤醒(Daily Interruption Sedation, DIS);频率对重症监护病房(Intensive Care Unit, ICU)机械通气镇静患者应激反应的影响；探讨增加镇静患者唤醒频率的可行性。方法：将入住我科ICU病房、应用呼吸机的危重患者用急性生理学及慢性健康状态评分系统(Acute physiology And Chronic Health EvaluationⅡ, APACHEⅡ)进行评分,APACHEⅡ评分>16分的30例患者随机分为对照组和试验组。各组均使用闭环靶控输注异丙酚和微量泵输注芬太尼进行镇静、镇痛治疗,闭环靶控的目标BIS值设定为80至60。对照组(Ⅰ组)：每日唤醒0次；实验组：Ⅱ组：每日唤醒一次、以及Ⅲ组：每日唤醒二次。每1h记录平均动脉压MAP、RR、SPO2、HR值和Ramsay评分及对应BIS监测值；每4h监测手指血糖一次；检测0h(T0)、12h(T1)、24h(T2)血清COR、ACTH浓度；记录24h异丙酚的总用量。结果：观察所有研究对象(n=30)的BIS值和Ramsay评分具有较好的相关(rs=0.897,P<0.001)；BIS值在60至80范围时间百分比79.9%。三组异丙酚对用量无明显统计学差异(P>0.05)。三组MAP、SPO2组内、组间变化无明显统计学差异(P>0.05);心率及呼吸变化组内变化无明显统计学差异(P>0.05)，三组间Ⅲ组较Ⅰ组、Ⅱ组有升高,有显著统计学差异(P<0.05)。三组T0、T1、T2各个时间点组间ACTH无统计学差异(P>0.05)；Ⅰ组组内呈先下降后升高趋势T1点较T0点比较以及T2较T1比较有显著统计学差异(P<0.05)；T2点较TO点比较无显著统计学差异。Ⅱ组、Ⅲ组组内ACTH均呈上升趋势各组T2点较TO点比较以及T2较T1比较有显著统计学差异(P<0.05)；T1点较TO点比较无显著统计学差异。Ⅰ组COR呈现下降趋势T1较T0有显著统计学意义(P<0.05),T2较T0、T1比较无统计学意义(P>0.05)；Ⅱ组COR先下降后升高T1较T0比较下降无统计学差异(P>0.05),T2较T0、T1升高有显著统计学差异(P<0.05)；Ⅲ组COR呈现升高趋势T2较TO有统计学意义(P<0.05)；三组T0、T1、T2各个时间点组间COR无统计学差异(P>0.05)。三组血糖比较无明显差异(P>0.05)。结论：根据生命体征及应激激素的变化判断：随每日唤醒次数增加,应用呼吸机的镇静患者的应激有升高的趋势；应用呼吸机、连续镇静的危重病患者,施行每日唤醒安全可行,不增加意外发生率。

引用

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