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Chest:镇痛镇静的深度对使用机械通气的急诊患者预后的影响

2017-06-30 MedSci MedSci原创

镇痛和镇静是机械通气患者治疗中的基本手段。目前已经有数据显示对ICU患者进行早期深度镇静可影响患者预后,但在急诊科(ED)却没有对此进行过调查。因此,镇静镇痛的深度对急诊科患者预后的影响仍属未知。本研究的目的是为了明确如何对急诊患者实施镇静镇痛,以及镇静镇痛对急诊机械通气患者预后会产生不同影响这一假说进行验证。

镇痛和镇静是机械通气患者治疗中的基本手段。目前已经有数据显示对ICU患者进行早期深度镇静可影响患者预后,但在急诊科(ED)却没有对此进行过调查。因此,镇静镇痛的深度对急诊科患者预后的影响仍属未知。本研究的目的是为了明确如何对急诊患者实施镇静镇痛,以及镇静镇痛对急诊机械通气患者预后会产生不同影响这一假说进行验证。

本研究在单一的学术医疗中心对登记在册的成人机械通气患者进行前瞻性队列研究。医院死亡率是研究的主要结果,研究的次要结果为总住院天数、ICU住院天数、使用呼吸机天数。使用回顾性多变量logistic回归模型对急诊患者的镇静深度进行分析,使用Richmond镇痛镇静评分表(RASS)对镇静镇痛深度进行评估。

研究总共纳入414例患者,其中有354名(85.5%)患者使用芬太尼进行镇静,254名(61.3%)接受咪达唑仑,194名(46.9%)接受丙泊酚。对其中244例(64%)患者进行了深度镇静。调整混杂因素后得出,镇静深度和急诊患者死亡率有显著关联 [ AOR 0.77,95% CI(0.63 - 0.94)]。

从而我们可以得出,对急诊接受机械通气的患者进行早期深度镇静可作为常规治疗,且接受深度镇静的患者死亡率较低。这些数据还表明,急诊患者的镇静深度是一项可变量,可以有针对性的调整以改善患者预后。

原始出处:


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    2017-07-24 Smile2680
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    2017-07-02 zhaojie88
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