不同镇静方案对机械通气患者的影响

Usama Badr, Hossam Fouad Rida, Amr A Elmorsy
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摘要

背景:全世界多达三分之一的重症监护病房(ICU)患者接受机械通气。这些患者经常需要使用镇痛药和镇静剂,这些强效药物具有明显的疗效和明显的副作用。目的:本研究旨在评估不同镇静方案对机械通气患者使用呼吸机天数、住院时间、多器官功能障碍、呼吸机相关性肺炎(VAP)和死亡率的影响。方法:将100例因任何原因插管并机械通气超过24小时的成年患者纳入本研究。用于镇静的药物是异丙酚和咪达唑仑。患者入院时接受病史、临床检查、实验室检查、胸片及心电图检查。结果:在本研究结束时,我们发现镇静假期组(II组)在多器官功能障碍评分、VAP、呼吸机天数、ICU住院时间和住院时间方面明显高于未镇静组(I组),但两组在死亡率、自主呼吸试验、格拉斯哥昏迷评分和全血细胞计数方面无显著差异。结论:我们的研究结果表明,使用镇静剂会导致机械通气时间延长,ICU住院时间延长,总住院时间延长。此外,发病率和死亡率的风险也在增加。对危重病人进行机械通气时,可以使用不镇静的策略,而不必担心失败。
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Effects of different regimens of sedation on mechanically ventilated patients
Background: Up to one-third of intensive care unit (ICU) patients worldwide undergo mechanical ventilation. These patients frequently require analgesics and sedatives-potent medications with clear benefits and significant side effects. Objective: The current study intended to assess the effects of application of different regimens of sedation on mechanically ventilated patients regarding the length of ventilator days, length of hospital stay, multiple organ dysfunctions, ventilator-associated pneumonia (VAP), and mortality. Methods: One hundred adult patients who are intubated for any cause and attached to mechanical ventilation for more than 24 h will be included in this study. Drugs used for sedation were propofol and midazolam. Patients underwent history taking, clinical examination, laboratory investigations, chest X-ray, and electrocardiogram on admission. Results: At the end of this study, it was found that there was a significant increase in the sedation holiday group (Group II) over the no sedation group (Group I) regarding multiple organ dysfunction score, VAP, ventilator days, ICU stay, and hospital stay but there was no significant difference between both groups regarding mortality, spontaneous breathing trials, Glasgow Coma Scale, and complete blood count. Conclusions: Our results demonstrate that the use of sedatives can cause prolongation in the duration of mechanical ventilation, length of stay in the ICU, and total length of hospital stay. In addition, there is an increased risk of morbidity and mortality. It is possible to use a strategy of no sedation for critically ill patients undergoing mechanical ventilation without fears of failure.
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