ABCDE镇静镇痛集束对机械通气患者呼吸力学的影响研究

发布时间：2018-10-12 13:05

【摘要】：目的:在对机械通气实施镇静镇痛药物治疗时,采用ABCDE镇静镇痛集束化护理(ABCDE Bundle),观察在两种不同护理干预策略实施下机械通气患者的呼吸力学、血气分析指标的变化,探讨ABCDE Bundle的临床实践意义,提出应用最佳护理策略改善机械通气患者呼吸力学指标及氧合指数,为提高机械通气患者预后提供临床参考。方法:143例机械通气患者纳入本试验。将两种不同护理干预策略按入科前后顺序实施于每位患者,依次为:常规组,采用常规镇痛镇静护理策略。Bundle组,应用ABCDE Bundle。比较两组机械通气患者在不同护理策略实施前后不同时间点平台压(Pplat)、气道峰压(Ppeak)、动态顺应性(Cdny)和潮气量(VT)、动脉血氧饱和度(SaO2)、氧合指数(PaO2/FiO2)、动脉血氧分压(PaO2)、酸碱度(PH)、动脉血二氧化碳分压(PaCO2)的变化,以及两组患者镇静镇痛药物使用剂量、谵妄发生率、28d生存情况、ICU住院日、机械通气时间的比较。统计数据应用SPSS17.0建立数据库,计量资料用(x±S)表示,计数资料用频数、百分比(%)表示,两种不同护理策略重复测量比较应用重复测量资料方差分析,以P0.05为差异有统计学意义。结果:1.对机械通气患者呼吸力学指标的影响:实施干预前两组机械通气患者呼吸力学指标比较(P0.05);实施干预后bundle组Ppeak、Pplat、Cdny和VT改善明显,优于常规组(P0.05);同一组不同监测时间点比较,与干预前比较,bundle组干预3d、5d、7d后Ppeak、Pplat、Cdny、VT观察指标变化明显,差异有统计学意义(P0.05);常规组干预5d、7d后各个呼吸力学指标与干预前比较差异有统计学意义(P0.05);2.对机械通气患者血气分析的影响:实施干预前两组机械通气患者SaO2、PaO2/FiO2、PaO2、PaCO2指标比较,差异无统计学意义(P0.05),实施干预后,Bundle组SaO2、PaO2/FiO2、PaO2、随着干预时间的延长逐渐升高,优于常规组(P0.05);同一组不同监测时间点比较,常规组干预第5d、7d后与Bundle组干预第3d、5d、7d后各个血气分析指标与干预前比较,差异有统计学意义(P0.05);3.对机械通气患者预后指标的影响:Bundle组预后优于常规组(P0.05),Bundle组可缩短机械通气时间及ICU住院日,减少镇痛镇静药物使用剂量,降低谵妄发生率及28d病死率,改善预后;结论:1.两种镇静镇痛护理策略均可提高机械通气患者的氧和指数,改善患者的呼吸力学监测指标。2.采用ABCDE Bundle可更快改善机械通气患者气道峰压、平台压,更大程度增加肺动态顺应性和潮气量;使患者对机械通气的耐受性更强,明显缩短机械通气时间,提高患者的动脉氧合指数,提高氧和水平,减少镇静镇痛药物的使用剂量,降低谵妄的发生率和28d病死率,改善患者预后。因此,ABCDE Bundle策略,可更精确的加强机械通气患者镇静镇痛管理过程,更有效的提高ICU机械通气患者镇静镇痛管理效率。3.在对两组机械通气患者实施试验过程中,两组患者均无不良事件发生,ABCDE Bundle应用过程中未出现低氧血症等严重并发症,因此,集束化镇静镇痛是一种安全有效的护理措施,值得临床推广。
[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.
【学位授予单位】：石河子大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473

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