ABCDE鎮(zhèn)靜鎮(zhèn)痛集束對機械通氣患者呼吸力學的影響研究
發(fā)布時間：2018-10-12 13:05
【摘要】：目的:在對機械通氣實施鎮(zhèn)靜鎮(zhèn)痛藥物治療時,采用ABCDE鎮(zhèn)靜鎮(zhèn)痛集束化護理(ABCDE Bundle),觀察在兩種不同護理干預(yù)策略實施下機械通氣患者的呼吸力學、血氣分析指標的變化,探討ABCDE Bundle的臨床實踐意義,提出應(yīng)用最佳護理策略改善機械通氣患者呼吸力學指標及氧合指數(shù),為提高機械通氣患者預(yù)后提供臨床參考。方法:143例機械通氣患者納入本試驗。將兩種不同護理干預(yù)策略按入科前后順序?qū)嵤┯诿课换颊?依次為:常規(guī)組,采用常規(guī)鎮(zhèn)痛鎮(zhèn)靜護理策略。Bundle組,應(yīng)用ABCDE Bundle。比較兩組機械通氣患者在不同護理策略實施前后不同時間點平臺壓(Pplat)、氣道峰壓(Ppeak)、動態(tài)順應(yīng)性(Cdny)和潮氣量(VT)、動脈血氧飽和度(SaO2)、氧合指數(shù)(PaO2/FiO2)、動脈血氧分壓(PaO2)、酸堿度(PH)、動脈血二氧化碳分壓(PaCO2)的變化,以及兩組患者鎮(zhèn)靜鎮(zhèn)痛藥物使用劑量、譫妄發(fā)生率、28d生存情況、ICU住院日、機械通氣時間的比較。統(tǒng)計數(shù)據(jù)應(yīng)用SPSS17.0建立數(shù)據(jù)庫,計量資料用(x±S)表示,計數(shù)資料用頻數(shù)、百分比(%)表示,兩種不同護理策略重復(fù)測量比較應(yīng)用重復(fù)測量資料方差分析,以P0.05為差異有統(tǒng)計學意義。結(jié)果:1.對機械通氣患者呼吸力學指標的影響:實施干預(yù)前兩組機械通氣患者呼吸力學指標比較(P0.05);實施干預(yù)后bundle組Ppeak、Pplat、Cdny和VT改善明顯,優(yōu)于常規(guī)組(P0.05);同一組不同監(jiān)測時間點比較,與干預(yù)前比較,bundle組干預(yù)3d、5d、7d后Ppeak、Pplat、Cdny、VT觀察指標變化明顯,差異有統(tǒng)計學意義(P0.05);常規(guī)組干預(yù)5d、7d后各個呼吸力學指標與干預(yù)前比較差異有統(tǒng)計學意義(P0.05);2.對機械通氣患者血氣分析的影響:實施干預(yù)前兩組機械通氣患者SaO2、PaO2/FiO2、PaO2、PaCO2指標比較,差異無統(tǒng)計學意義(P0.05),實施干預(yù)后,Bundle組SaO2、PaO2/FiO2、PaO2、隨著干預(yù)時間的延長逐漸升高,優(yōu)于常規(guī)組(P0.05);同一組不同監(jiān)測時間點比較,常規(guī)組干預(yù)第5d、7d后與Bundle組干預(yù)第3d、5d、7d后各個血氣分析指標與干預(yù)前比較,差異有統(tǒng)計學意義(P0.05);3.對機械通氣患者預(yù)后指標的影響:Bundle組預(yù)后優(yōu)于常規(guī)組(P0.05),Bundle組可縮短機械通氣時間及ICU住院日,減少鎮(zhèn)痛鎮(zhèn)靜藥物使用劑量,降低譫妄發(fā)生率及28d病死率,改善預(yù)后;結(jié)論:1.兩種鎮(zhèn)靜鎮(zhèn)痛護理策略均可提高機械通氣患者的氧和指數(shù),改善患者的呼吸力學監(jiān)測指標。2.采用ABCDE Bundle可更快改善機械通氣患者氣道峰壓、平臺壓,更大程度增加肺動態(tài)順應(yīng)性和潮氣量;使患者對機械通氣的耐受性更強,明顯縮短機械通氣時間,提高患者的動脈氧合指數(shù),提高氧和水平,減少鎮(zhèn)靜鎮(zhèn)痛藥物的使用劑量,降低譫妄的發(fā)生率和28d病死率,改善患者預(yù)后。因此,ABCDE Bundle策略,可更精確的加強機械通氣患者鎮(zhèn)靜鎮(zhèn)痛管理過程,更有效的提高ICU機械通氣患者鎮(zhèn)靜鎮(zhèn)痛管理效率。3.在對兩組機械通氣患者實施試驗過程中,兩組患者均無不良事件發(fā)生,ABCDE Bundle應(yīng)用過程中未出現(xiàn)低氧血癥等嚴重并發(fā)癥,因此,集束化鎮(zhèn)靜鎮(zhèn)痛是一種安全有效的護理措施,值得臨床推廣。
[Abstract]:Objective: To observe the changes of respiratory mechanics and blood gas analysis indexes of patients with mechanical ventilation under two different nursing intervention strategies in the treatment of sedation and analgesia with mechanical ventilation. In order to improve the prognosis of patients with mechanical ventilation, the authors put forward the application of the optimal nursing strategies to improve the respiratory mechanics indexes and the oxygen index of patients with mechanical ventilation. Methods: 143 patients with mechanical ventilation were included in this trial. Two different nursing intervention strategies were applied to each patient in the order before and after admission, in turn: routine group and conventional analgesic sedation and nursing strategy. Bundle group, ABBREBUNDLE is applied. Two groups of mechanical ventilation patients were compared at different time point platform pressure (Pplacat), airway peak pressure (Ppeak), dynamic compliance (Cny) and tidal volume (VT), arterial oxygen saturation (SaO2), oxygen occlusion index (PaO2/ FiO2) and PaO2 (PaO2) at different time points before and after different nursing strategies. The changes of pH value (PH), arterial carbon dioxide partial pressure (PaCO2), and the use dosage of sedative and analgesic drugs in the two groups were compared with those in ICU stay and mechanical ventilation time. Statistical data were used to establish database, and the data were expressed by (x/ S). The frequency, percentage (%) of counting data indicated that the repeated measurement data of two different nursing strategies were used repeatedly to measure the variance of data of variance, and the difference was statistically significant. Result: 1. The effects of mechanical ventilation on respiratory mechanics were compared with those of two groups before intervention (P0.05). The improvement of Ppeak, Pplat, Cdny and VT after intervention was obviously superior to that of routine group (P0.05). There was significant difference in Ppeak, Pplat, Cdny and VT after group intervention (P0.05). The effects of SaO2, PaO2/ FiO2, PaO2 and PaCO2 in two groups of mechanical ventilation before intervention were not statistically significant (P0.05). Compared with a group of different monitoring time points, the difference was statistically significant (P0.05). The results showed that the prognosis of patients with mechanical ventilation was superior to that of routine group (P0.05). The Bundle group could shorten the time of mechanical ventilation and the hospitalization days of ICU, reduce the use dosage of analgesic and sedative drugs, reduce the incidence of false alarm and 28d mortality, and improve the prognosis. Conclusion: 1. Both sedation and analgesia nursing strategies can improve the oxygen and index of patients with mechanical ventilation and improve the respiratory mechanics monitoring index of patients. ABBREBUNDLE can improve the airway peak pressure and plateau pressure of patients with mechanical ventilation faster, increase the dynamic compliance and tidal volume of the lungs, make the patient more tolerant to mechanical ventilation, shorten the mechanical ventilation time obviously, improve the arterial oxygen index of the patient, improve the oxygen and the level, Reducing the use dose of sedation and analgesia drugs, reducing the incidence of false alarm and the 28day mortality rate, and improving the prognosis of patients. Therefore, ABSBundle strategy can more accurately strengthen the sedation and analgesia management process of mechanical ventilation patients, and can effectively improve the sedation and analgesia management efficiency of patients with mechanical ventilation in ICU. There were no adverse events in both groups during the test of the two groups of mechanical ventilation. The severe complications such as hypoxemia and other serious complications were not observed in ABSBundle application. Therefore, it is a safe and effective nursing measure, which is worthy of clinical popularization.
【學位授予單位】：石河子大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R473
本文編號：2266222
[Abstract]:Objective: To observe the changes of respiratory mechanics and blood gas analysis indexes of patients with mechanical ventilation under two different nursing intervention strategies in the treatment of sedation and analgesia with mechanical ventilation. In order to improve the prognosis of patients with mechanical ventilation, the authors put forward the application of the optimal nursing strategies to improve the respiratory mechanics indexes and the oxygen index of patients with mechanical ventilation. Methods: 143 patients with mechanical ventilation were included in this trial. Two different nursing intervention strategies were applied to each patient in the order before and after admission, in turn: routine group and conventional analgesic sedation and nursing strategy. Bundle group, ABBREBUNDLE is applied. Two groups of mechanical ventilation patients were compared at different time point platform pressure (Pplacat), airway peak pressure (Ppeak), dynamic compliance (Cny) and tidal volume (VT), arterial oxygen saturation (SaO2), oxygen occlusion index (PaO2/ FiO2) and PaO2 (PaO2) at different time points before and after different nursing strategies. The changes of pH value (PH), arterial carbon dioxide partial pressure (PaCO2), and the use dosage of sedative and analgesic drugs in the two groups were compared with those in ICU stay and mechanical ventilation time. Statistical data were used to establish database, and the data were expressed by (x/ S). The frequency, percentage (%) of counting data indicated that the repeated measurement data of two different nursing strategies were used repeatedly to measure the variance of data of variance, and the difference was statistically significant. Result: 1. The effects of mechanical ventilation on respiratory mechanics were compared with those of two groups before intervention (P0.05). The improvement of Ppeak, Pplat, Cdny and VT after intervention was obviously superior to that of routine group (P0.05). There was significant difference in Ppeak, Pplat, Cdny and VT after group intervention (P0.05). The effects of SaO2, PaO2/ FiO2, PaO2 and PaCO2 in two groups of mechanical ventilation before intervention were not statistically significant (P0.05). Compared with a group of different monitoring time points, the difference was statistically significant (P0.05). The results showed that the prognosis of patients with mechanical ventilation was superior to that of routine group (P0.05). The Bundle group could shorten the time of mechanical ventilation and the hospitalization days of ICU, reduce the use dosage of analgesic and sedative drugs, reduce the incidence of false alarm and 28d mortality, and improve the prognosis. Conclusion: 1. Both sedation and analgesia nursing strategies can improve the oxygen and index of patients with mechanical ventilation and improve the respiratory mechanics monitoring index of patients. ABBREBUNDLE can improve the airway peak pressure and plateau pressure of patients with mechanical ventilation faster, increase the dynamic compliance and tidal volume of the lungs, make the patient more tolerant to mechanical ventilation, shorten the mechanical ventilation time obviously, improve the arterial oxygen index of the patient, improve the oxygen and the level, Reducing the use dose of sedation and analgesia drugs, reducing the incidence of false alarm and the 28day mortality rate, and improving the prognosis of patients. Therefore, ABSBundle strategy can more accurately strengthen the sedation and analgesia management process of mechanical ventilation patients, and can effectively improve the sedation and analgesia management efficiency of patients with mechanical ventilation in ICU. There were no adverse events in both groups during the test of the two groups of mechanical ventilation. The severe complications such as hypoxemia and other serious complications were not observed in ABSBundle application. Therefore, it is a safe and effective nursing measure, which is worthy of clinical popularization.
【學位授予單位】：石河子大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R473
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