|
|
Influencing factors analysis of sedative tolerance in ICU patients on mechanical ventilation#br# |
HUANG Bing1 TANG Zhihong2 TANG Li1 |
1.Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Sichuan Province, Chengdu 610041, China;
2.Department of Intensive Care, West China Hospital, Sichuan University, Sichuan Province, Chengdu 610041, China |
|
|
Abstract Objective To investigate the influencing factors of sedative tolerance in ICU patients, so as to provide reference for formulating corresponding medical care measures. Methods Electronic medical records of 372 patients undergoing sedative and analgesic mechanical ventilation in West China Hospital, Sichuan University from February 2017 to March 2021 were retrospectively collected, and they were divided into the tolerant group (60 cases) and the non-tolerant group (312 cases) according to the incidence of sedative tolerance. Univariate analysis and logistic regression model were used to explore the factors associated with sedative tolerance in patients. Results The age, scores of acute physiology and chronic health evaluationⅡ (APACHE Ⅱ) in the tolerant group were lower than those in the non-tolerant group, the body mass index, proportion of patients with drinking history and repeated intermitten push injection were higher than those in the non-tolerant group, the use time of sedative was longer than that of non-tolerant group, and the differences were statistically significant (P < 0.05). Multivariate analysis showed that age, APACHE Ⅱ score, alcohol consumption, duration of sedative use, and repeated intermitten push injection were independent influencing factors of sedative tolerance (P < 0.05). Conclusion For patients who are prone to sedative tolerance after sedative and analgesic mechanical ventilation, clinical attention should be paid to the use of sedative drugs in severe patients and management standards should be formulated, and measures should be actively taken to reduce the occurrence of sedative tolerance and protect the safety of patients.
|
|
|
|
|
[1] 中华医学会重症医学分会.中国成人ICU镇痛和镇静治疗指南[J].中华危重病急救医学,2018,30(6):497-514.
[2] 刘京涛,马朋林.ICU机械通气患者的镇静与镇痛:指南vs现实[J].中华重症医学电子杂志,2017,3(4):241-244.
[3] 张久之,李青栋,万献尧.ICU患者的浅镇静:我们追求的目标?[J].医学与哲学,2013,34(12):7-9,88.
[4] Taylor D. Iatrogenic drug dependence——a problem in intensive care?Case study and literature review [J]. Intensive Crit Care Nurs,1999,15(2):95-100.
[5] Su Y,Wang M,Liu Y,et al. Module modified acute physiology and chronic health evaluationⅡ:predicting the mortality of neuro-critical disease [J]. Neurol Res,2014,36(12):1099-1105.
[6] Woods JC,Mion LC,Connor JT,et al. Severe agitation among ventilated medical intensive care unit patients:frequency,characteristics and outcomes [J]. Intensive Care Med,2004,30(6):1066-1072.
[7] Oks M,Cleven KL,Healy L,et al. The Safety and Utility of Phenobarbital Use for the Treatment of Severe Alcohol Withdrawal Syndrome in the Medical Intensive Care Unit [J]. J Intensive Care Med,2020,35(9):844-850.
[8] 李秀华.重症专科护理[M].北京:人民卫生出版社,2018:37-40.
[9] Zapantis A,Leung S. Tolerance and withdrawal issues with sedation [J]. Crit Care Nurs Clin North Am,2005,17(3):211-223.
[10] Weerink MAS,Barends CRM,Muskiet ERR,et al. Pharmacodynamic Interaction of Remifentanil and Dexmedetomidine on Depth of Sedation and Tolerance of Laryngoscopy [J]. Anesthesiology,2019,131(5):1004-1017.
[11] de Wit M,Yin Wad S,Gill J,et al. Prevalence and impact of alcohol and other drug use disorders on sedation and mechanical ventilation:a retrospective study [J]. BMJ Anesthesiol,2007,7:3-9.
[12] Sandiumenge A,Torrado H,Mu?觡oz T,et al. Impact of harmful use of alcohol on the sedation of critical patients on mechanical ventilation:A multicentre prospective,observational study in 8 Spanish intensive care units [J]. Med Intensiva,2016,40(4):230-237.
[13] 于敏,张双庆,闻镍,等.细胞色素P450酶系体外药物代谢研究方法进展[J].中国药事,2013,27(1):81-87.
[14] Frierman DE,Melinkov Z,Nanji AA. Induction of CYP3A by ethanol in multiple in vitro and in vivo models [J]. Alcohol Clin Exp Res,2003,27(6):981-988.
[15] 刘大为.重症医学[M].北京:人民卫生出版社,2017:397-399.
[16] 邓艳丽,李梅华.ICU探视制度对酒精戒断综合征患者临床症状和不良反应的影响[J].中国护理管理,2016, 16(7):949-952.
[17] 管向东.重症医学[M].北京:中华医学电子音像出版社,2019:232-239.
[18] 蒋国平,田昕.中国成人ICU镇痛和镇静治疗2018指南解读[J].浙江医学,2018,40(16):9-14,18.
[19] 郭晓夏,安友仲.ICU后综合征在镇痛镇静谵妄指南、镇痛镇静集束化措施及eCASH中的干预建议[J].中华重症医学电子杂志,2017,3(4):250-253.
[20] 周丹,杨青敏,唐建国,等.基于eCASH理念的舒适化浅镇静方案在机械通气患者中的应用效果研究[J].护士进修杂志,2020,35(11):1033-1036.
[21] 周丹,杨青敏.“以护士为主导,以病人为中心”的舒化浅镇静方案对我国镇静镇痛临床实践的启示[J].护理研究,2019,33(2):318-322.
[22] 许峰.国内外镇痛镇静指南理念的进展[J].中国小儿急救医学,2020,27(2):84-85.
[23] 马亮.EGDS策略在ICU机械通气患者中的镇静、镇痛效果分析[J].中国现代医生,2021,59(27):139-142.
[24] 王导新,邓旺.重视机械通气患者镇静镇痛个体化策略[J].中华结核和呼吸杂志,2019,42(9):652-655.
[25] 张迪颖,樊柳,孙红果.躁动镇静评分在重症医学科机械通气患者中的应用效果[J].中国当代医药,2020,27(1):197-199.
[26] 吴苏华,梁国源,戚应静.布托啡诺联合右美托咪定对机械通气患者镇痛镇静的效果观察[J].中国医药科学,2020,10(20):92-95.
[27] 蔡诗凝,张玉侠,潘文彦,等.ICU术后的机械通气患者镇静水平及其影响因素研究[J].中国实用护理杂志,2020, 36(12):913-918.
[28] 李淼,谢碧占.人文关怀理念在ICU机械通气患者镇痛镇静的护理实践[J].中国当代医药,2021,28(15):269-273.
[29] 周丹,杨青敏,唐建国,等.ICU浅镇静患者非药物睡眠干预方案的构建研究[J].中华护理杂志,2020,55(5):645-651. |
|
|
|