摘要
目的:通过比较早期目标导向镇静(EGDS)策略、改良EGDS策略、标准镇静(STDS)策略对严重创伤患者预后的影响,为今后严重创伤患者镇静策略的选择提供一定的依据。方法:选取我院严重创伤患者120例,随机分为EGDS组、改良EGDS组、STDS组各40例,在入组后48 h及7 d评估患者镇静情况,并统计住院期间不良事件发生情况及相关预后指标,在患者出科前1 d评估患者心理状态及认知功能。结果:①入组48 h浅镇静比例:EGDS组(67%)及改良EGDS组(75%)均高于STDS组(40%)(P<0.05);②3组患者在非计划拔管率、气管切开率、VAP、病死率方面差异无统计学意义,改良EGDS组谵妄发生率低于STDS组(P<0.05),改良EGDS组及EGDS组物理约束率均低于STDS组(P<0.05),而EGDS组的心动过缓发生率高于STDS组(P<0.05);③改良EGDS组及EGDS组7 d内拔管率高于STDS组(P<0.05),在机械通气时间,ICU住院时间,住院总费用方面,改良EGDS组及EGDS组均低于STDS组(P<0.05),在镇静镇痛药物费用方面,改良EGDS低于EGDS组,低于STDS组(P<0.05);④出科前1 d 3组患者在躯体化、强迫、人际关系、焦虑、敌对、恐怖、偏执、精神病性评分方面均差异无统计学意义,在焦虑、抑郁评分、认知功能评分方面,改良ECDS组及EGDS组均低于STDS组(P<0.05)。结论:改良EGDS策略及EGDS策略均都能够使患者尽早达到浅镇静状态,减少患者住院期间不良事件发生,缩短机械通气时间及住院时间,降低住院费用,并能改善患者出科后心理状况及认知功能,但对比于EGDS策略,改良EGDS策略是一种能更有效、更安全,更经济的策略。
Objective:By comparing the effects of early goal-directed sedation(EGDS) strategy, modified EGDS strategy and standard sedation(STDS) strategy on the prognosis of patients with severe trauma, it will provide a basis for the selection of the optimal sedation strategy of severely trauma patients in the future. Method:We choose 120 patients with severe traumain our hospital were randomly divided into EGDS strategy group, modified EGDS strategy group, standard sedation strategy group,with 40 cases in each group. The patient ’s sedation status distribution was assessed at 48 h and seventh day after admission, and adverse events and related prognostic indicators were counted. The psychological status and cognitive function of patients were evaluated one day before the patients were discharged. Result:①The proportion of light sedation within 48 h of the EGDS group(67%) and the modified EGDS group(75%) were higher than the STDS group(40%)(P<0.05);②There were no significant differences in unplanned extubation rate, tracheotomy rate, VAP and mortality among the three groups.The incidence of delirium in the modified EGDS group was lower than that in the STDS group(P<0.05). Both the modified EGDS group and the EGDS group had lower physical constraint rates than the STDS group(P<0.05). The incidence of bradycardia in EGDS group was higher than that in the STDS group(P<0.05);③The extubation rate of the modifid EGDS group and the EGDS group within 7 days was higher than that of the STDS group(P<0.05). The modifid EGDS group and the EGDS group had lower mechanical ventilation duration, length of ICU stay, and total hospitalization costs than the STDS group(P<0.05). In terms of sedative and analgesic drug costs, the modifid EGDS group were lower than those of the EGDS group and the STDS group(P<0.05);④There was no significant difference in somatization, coercion, interpersonal relationship, hostility, terror, paranoia and psychiatric scores among the three groups, while the scores of anxiety, depression and cognitive function in the modified EGDS group and EGDS group were lower than those in the STDS group(P<0.05). Conclusion:Both the modified EGDS strategy and EGDS strategy can enable patients to-achieve light sedation state as soon as possible, reduce the rate of adverse events, shorten the time of mechanical ventilation and the duration of hospital stay, reduce hospitalization expenses and improve psychological status of patients after discharge. Compared with the EGDS strategy, the modified EGDS strategy is a more effective, safer and more economical strategy.
作者
王颖
朱浩
陈金亮
陈建荣
WANG Ying;ZHU Hao;CHEN Jinliang;CHEN Jianrong(Department of Critical Care Medicine,the Second Affiliated Hospital of Nantong University,Nantong,Jiangsu,226001,China)
出处
《临床急诊杂志》
CAS
2020年第3期192-197,共6页
Journal of Clinical Emergency
基金
江苏省南通市卫计委青年科技项目(No:WQ2016033).
关键词
改良早期目标导向镇静
严重创伤
音乐疗法
心理状况
认知功能
modified early goal-directed sedation
severe trauma
music therapy
psychological condition
cognitive function
作者简介
通信作者:陈建荣,E-mail:drchenjr@163.com
