本文關鍵詞： 呼吸機相關性肺炎 鎮(zhèn)靜治療 相關因素　出處：《南方醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：研究背景呼吸機使用是ICU患者搶救治療的重要方法之一,應用呼吸機后常見并發(fā)癥是呼吸機相關性肺炎,呼吸機相關性肺炎的發(fā)生不僅延長患者的住院時間,而且還是死亡的重要因素之一。在行機械通氣過程中,患者常常出現(xiàn)煩躁不適、人機對抗等,往往需要使用鎮(zhèn)靜藥物渡過機械通氣期,但長時間鎮(zhèn)靜抑制了患者的咳嗽反射,影響氣道分泌物清除,增加肺部感染的危險,因此,呼吸機相關性肺炎的發(fā)生與鎮(zhèn)靜治療有密切關系。目前,ICU普遍存在不恰當?shù)逆?zhèn)靜,如何達到理想的鎮(zhèn)靜是困擾臨床的重要課題。研究目的探討重癥監(jiān)護室機械通氣患者呼吸機相關性肺炎(VAP)發(fā)生與鎮(zhèn)靜治療的相關因素,為機械通氣患者合理應用鎮(zhèn)靜藥提供指導,從而預防鎮(zhèn)靜劑帶來的各種并發(fā)癥,通過改善鎮(zhèn)靜策略,降低VAP的發(fā)生,降低病死率。研究方法本研究采用回顧性調(diào)查分析某三甲醫(yī)院ICU 2014年7月-2016年6月行機械通氣同時使用鎮(zhèn)靜藥的218例患者的臨床資料,呼吸機應用時間超過48h,且機械通氣前無肺部感染,全部使用靜脈持續(xù)泵入丙泊酚或力月西及采用RASS鎮(zhèn)靜評分。臨床護理評估:血壓、心率、血氧飽和度、呼吸等。根據(jù)入選標準和排除標準確定研究對象,首先在某三甲醫(yī)院ICU電腦系統(tǒng)的護士工作站輸入“呼吸機鋪助呼吸”,時間選定在2014年7月至2016年6月,共檢出571例機械通氣患者,按設定條件“行機械通氣超過48h患者”納入研究對象,初步篩選出行機械通氣超過48h患者302例,再按條件“行機械通氣同時使用鎮(zhèn)靜藥物患者”及剔除干擾項和明顯不符合納人標準的患者,最后篩選出行機械通氣同時使用鎮(zhèn)靜藥物的患者218例,統(tǒng)計218例機械通氣患者總的鎮(zhèn)靜時間,鎮(zhèn)靜評分,機械通氣時間,住ICU時間。以是否發(fā)生VAP進行分組,發(fā)生VAP為觀察組,未發(fā)生VAP為對照組,比較兩組患者在鎮(zhèn)靜時間、鎮(zhèn)靜評分、機械通氣時間、住ICU時間的差異。研究結(jié)果VAP發(fā)生情況:218例機械通氣患者中61例發(fā)生VAP(27.98%)、157例未發(fā)生VAP(72.02%)。入科時兩組患者年齡、性別、心率、呼吸頻率、平均動脈壓、急性生理與慢性健康評分,差異無統(tǒng)計學意義(P0.05)。兩組患者在預防呼吸機相關性肺炎集束化策略措施是一致的,所以兩組具有可比性。觀察組61例患者總的鎮(zhèn)靜時間為7.51±7.86天,鎮(zhèn)靜評分為-2.69±1.09分,機械通氣時間為8.52±17.11天,住ICU時間24.44±21.93天,對照組157例患者總的鎮(zhèn)靜時間為3.83±2.91天,鎮(zhèn)靜評分為-1.22±1.52分,機械通氣時間為6.47±5.70天,住ICU時間11.63±7.49天。兩組差異有顯著統(tǒng)計學意義(P0.01)。研究結(jié)論本文通過研究機械通氣同時使用鎮(zhèn)靜藥的218例患者的臨床資料,分析機械通氣患者VAP發(fā)生與鎮(zhèn)靜治療的相關因素。通過研究表明機械通氣患者鎮(zhèn)靜時間、深度與VAP發(fā)生具有相關性,從而在臨床上為機械通氣患者行鎮(zhèn)靜治療時如何降低VAP的發(fā)生提供了依據(jù),通過在鎮(zhèn)靜策略上進行改進,降低VAP的發(fā)生率。
[Abstract]:On the background of the use of ventilator is one of the important methods for patients with ICU treatment, application of respirator is a common complication after ventilator-associated pneumonia, the incidence of ventilator-associated pneumonia not only prolonged hospitalization or death, and one of the important factors. In the process of mechanical ventilation, patients often appear irritability discomfort, man-machine confrontation, often need to use sedative drugs through mechanical ventilation, but long time sedation suppresses cough reflex in patients with the effect of airway secretion clearance, increase the risk of pulmonary infection, therefore, has a close relation with the sedative treatment of respiratory machine related pneumonia. At present, ICU is not appropriate sedation, how to achieve the ideal of sedation is an important subject of clinical problems the study. Objective to investigate the mechanical ventilation in ICU patients with ventilator-associated pneumonia (VAP) and sedative treatment occurred The related factors, to provide guidance for the reasonable application of sedative drugs in patients with mechanical ventilation, and the prevention of complications caused by improving sedation, sedation strategies, reduce the incidence of VAP, reduce the mortality rate. Methods in this study 218 cases of investigation and analysis of a hospital in ICU July 2014 -2016 year in June for mechanical ventilation and the use of sedative drugs the patients, ventilator time more than 48h, and before mechanical ventilation without pulmonary infection, all of the use of intravenous infusion of propofol or midazolam and the RASS sedation score. Clinical nursing assessment: blood pressure, heart rate, oxygen saturation, respiration and so on. According to the inclusion criteria and exclusion criteria to determine the object of study, first enter nurse a hospital ICU workstation computer system aided ventilator breathing ", the selected time in July 2014 to June 2016, there were 571 cases of patients with mechanical ventilation According to the conditions set, "mechanical ventilation for more than 48h patients enrolled in the study, preliminary screening of travel mechanical ventilation for more than 302 cases of 48h patients, according to the condition of mechanical ventilation and the use of sedative drugs in patients with" and eliminate interference term and obviously does not meet the inclusion criteria of patients, the screening of 218 patients with mechanical ventilation and travel the use of sedative drugs, 218 cases of patients with mechanical ventilation the total sedation time, sedation score, mechanical ventilation time, ICU stay time. According to whether the occurrence of VAP group, VAP in the observation group, without VAP as control group, compared two groups of patients in the sedation time, sedation score, duration of mechanical ventilation, the difference to live the time of ICU. Results: 218 cases of VAP patients with mechanical ventilation in 61 cases of VAP (27.98%), 157 cases without VAP (72.02%). The patients of the two groups, age, gender, heart rate, respiratory rate, mean arterial pressure , acute physiology and chronic health score, the difference was not statistically significant (P0.05). The two groups of patients are consistent in the prevention of ventilator-associated pneumonia cluster strategy measures, so the two groups were comparable. Observe the sedation time of patients with the total group of 61 patients was 7.51 + 7.86 days, sedation score for -2.69 + 1.09, mechanical ventilation time was 8.52 + 17.11 days, ICU stay time 24.44 + 21.93 days, with the total sedation time control group of 157 cases was 3.83 + 2.91 days, sedation score for -1.22 + 1.52, the duration of mechanical ventilation was 6.47 + 5.70 days, ICU stay time 11.63 + 7.49 days. There was significant difference between the two groups (P0.01). The clinical data of 218 patients with the conclusion of the study through the study of mechanical ventilation and the use of sedative drugs, analysis of related factors and sedative treatment of patients with VAP mechanical ventilation. Patients with mechanical ventilation. The time that through research, depth and VAP has occurred Therefore, it can provide a basis for reducing the incidence of VAP in patients undergoing mechanical ventilation during sedation treatment. We should improve the sedation strategy to reduce the incidence of VAP.

【學位授予單位】：南方醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R563.1

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