中国中西医结合急救杂志
中國中西醫結閤急救雜誌
중국중서의결합급구잡지
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
2015年
5期
508-512
,共5页
深度镇静%危重症%机械通气%病死率
深度鎮靜%危重癥%機械通氣%病死率
심도진정%위중증%궤계통기%병사솔
Deep sedation%Critical illness%Mechanical ventilation%Mortality
目的 分析过度镇静对重症加强治疗病房(ICU)机械通气患者预后的影响.方法 回顾性分析2009年1月至2014年11月入住安徽省六安市人民医院重症医学科214例行机械通气成人患者的病例资料,记录患者入院时的各项生理学参数、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、血管活性药物的使用剂量和时间等.主要临床结局为ICU病死率.按照患者入院48 h镇静剂使用情况,将Richmond躁动-镇静评分量表(RASS)评分为-5~-4分定义为深度镇静,计算患者深度镇静的发生率;采用多变量logistic回归分析患者不良预后是否与过度镇静相关.结果 共214例患者入选,ICU总体病死率为36.92%(79/214);深度镇静组114例,轻度镇静组100例.与存活组(135例)比较,死亡组(79例)患者年龄更大(岁:60.41±18.68比53.30±19.05,t=-2.653,P=0.009),APACHEⅡ评分更高(分:19.20±2.98比17.50±3.15, t=-3.904,P<0.001),深度镇静患者比例更高〔60.8%(48/79)比38.5%(52/135),χ2=9.903,P=0.002〕,去甲肾上腺素使用剂量更大(mg:62.8±12.4比34.7±7.5,t=2.055,P=0.043).与轻度镇静组比较,深度镇静组患者无合并症的比较更高〔22.0%(22/100)比10.5%(12/114),χ2=5.248,P=0.022〕,病死率更高〔48.0%(48/100)比27.2%(31/114),χ2=9.903,P=0.002〕.多变量logsitic回归分析显示,高龄〔优势比(OR)=1.020,95%可信区间(95%CI)=1.004~1.037,P=0.016〕、高APACHEⅡ评分(OR=1.182,95%CI=1.070~1.305,P=0.001)及深度镇静(OR=2.882,95%CI=1.543~5.382,P=0.001)是ICU机械通气患者死亡的独立危险因素.结论 深度镇静会增加ICU机械通气患者的病死率.
目的 分析過度鎮靜對重癥加彊治療病房(ICU)機械通氣患者預後的影響.方法 迴顧性分析2009年1月至2014年11月入住安徽省六安市人民醫院重癥醫學科214例行機械通氣成人患者的病例資料,記錄患者入院時的各項生理學參數、急性生理學與慢性健康狀況評分繫統Ⅱ(APACHEⅡ)評分、血管活性藥物的使用劑量和時間等.主要臨床結跼為ICU病死率.按照患者入院48 h鎮靜劑使用情況,將Richmond躁動-鎮靜評分量錶(RASS)評分為-5~-4分定義為深度鎮靜,計算患者深度鎮靜的髮生率;採用多變量logistic迴歸分析患者不良預後是否與過度鎮靜相關.結果 共214例患者入選,ICU總體病死率為36.92%(79/214);深度鎮靜組114例,輕度鎮靜組100例.與存活組(135例)比較,死亡組(79例)患者年齡更大(歲:60.41±18.68比53.30±19.05,t=-2.653,P=0.009),APACHEⅡ評分更高(分:19.20±2.98比17.50±3.15, t=-3.904,P<0.001),深度鎮靜患者比例更高〔60.8%(48/79)比38.5%(52/135),χ2=9.903,P=0.002〕,去甲腎上腺素使用劑量更大(mg:62.8±12.4比34.7±7.5,t=2.055,P=0.043).與輕度鎮靜組比較,深度鎮靜組患者無閤併癥的比較更高〔22.0%(22/100)比10.5%(12/114),χ2=5.248,P=0.022〕,病死率更高〔48.0%(48/100)比27.2%(31/114),χ2=9.903,P=0.002〕.多變量logsitic迴歸分析顯示,高齡〔優勢比(OR)=1.020,95%可信區間(95%CI)=1.004~1.037,P=0.016〕、高APACHEⅡ評分(OR=1.182,95%CI=1.070~1.305,P=0.001)及深度鎮靜(OR=2.882,95%CI=1.543~5.382,P=0.001)是ICU機械通氣患者死亡的獨立危險因素.結論 深度鎮靜會增加ICU機械通氣患者的病死率.
목적 분석과도진정대중증가강치료병방(ICU)궤계통기환자예후적영향.방법 회고성분석2009년1월지2014년11월입주안휘성륙안시인민의원중증의학과214례행궤계통기성인환자적병례자료,기록환자입원시적각항생이학삼수、급성생이학여만성건강상황평분계통Ⅱ(APACHEⅡ)평분、혈관활성약물적사용제량화시간등.주요림상결국위ICU병사솔.안조환자입원48 h진정제사용정황,장Richmond조동-진정평분량표(RASS)평분위-5~-4분정의위심도진정,계산환자심도진정적발생솔;채용다변량logistic회귀분석환자불량예후시부여과도진정상관.결과 공214례환자입선,ICU총체병사솔위36.92%(79/214);심도진정조114례,경도진정조100례.여존활조(135례)비교,사망조(79례)환자년령경대(세:60.41±18.68비53.30±19.05,t=-2.653,P=0.009),APACHEⅡ평분경고(분:19.20±2.98비17.50±3.15, t=-3.904,P<0.001),심도진정환자비례경고〔60.8%(48/79)비38.5%(52/135),χ2=9.903,P=0.002〕,거갑신상선소사용제량경대(mg:62.8±12.4비34.7±7.5,t=2.055,P=0.043).여경도진정조비교,심도진정조환자무합병증적비교경고〔22.0%(22/100)비10.5%(12/114),χ2=5.248,P=0.022〕,병사솔경고〔48.0%(48/100)비27.2%(31/114),χ2=9.903,P=0.002〕.다변량logsitic회귀분석현시,고령〔우세비(OR)=1.020,95%가신구간(95%CI)=1.004~1.037,P=0.016〕、고APACHEⅡ평분(OR=1.182,95%CI=1.070~1.305,P=0.001)급심도진정(OR=2.882,95%CI=1.543~5.382,P=0.001)시ICU궤계통기환자사망적독립위험인소.결론 심도진정회증가ICU궤계통기환자적병사솔.
Objective To assess the effect of over sedation on outcomes of critically ill adult patients under mechanical ventilation (MV) in intensive care unit (ICU).Methods The historical data of 214 adult patients with MV admitted to ICU in Lu'an City Hospital of Anhui Province from January 2009 to November 2014 were retrospectively analyzed. The physiological parameters, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, the dosage and days of vasoactive drugs used, etc were recorded after admission. The main clinical outcome was ICU mortality. According to the situation of sedative usage in 48 hours after patient's admission, the incidence of deep sedation was calculated, the definition of deep sedation being -4 to -5 Richmond agitation-sedation scale (RASS) scores. Multivariate logistic analysis was used to identify whether the patient's unfavorable outcome or mortality was correlated to deep sedation.Results A total of 214 patients were evaluated. Overall ICU mortality was 36.92% (79/214). 114 cases in deep sedation group, 100 cases in mild sedation group. Compared with survival group (135 cases), the patients in death group (79 cases) had older age (years: 60.41±18.68 vs. 53.30±19.05,t = -2.653,P = 0.009), higher APACHE Ⅱ scores (19.20±2.98 vs. 17.50±3.15,t = -3.904,P < 0.001), the higher rate of patients with deep sedation [60.8% (48/79) vs. 38.5% (52/135),χ2 = 9.903,P = 0.002], and the larger dose of norepinephrine used (mg: 62.8±12.4 vs. 34.7±7.5,t = 2.055,P = 0.043). Compared with mild sedation group, the patients in deep sedation group had high rate of non-complication [22.0% (22/100) vs. 10.5% (12/114),χ2 = 5.248,P = 0.022], and higher mortality [48.0% (48/100) vs. 27.2% (31/114),χ2 = 9.903,P = 0.002]. Multivariate logistic analyses showed, older age [odds ratio (OR) =1.020, 95% confidence interval (95%CI) = 1.004 - 1.037,P = 0.016], higher APACHE Ⅱ score (OR = 1.182, 95%CI = 1.070 - 1.305,P = 0.001) and deep sedation (OR = 2.882, 95%CI = 1.543 - 5.382, P = 0.001) were the independent risk factors associated with increased ICU mortality in critically ill patients under MV.Conclusion Deep sedation can increase the mortality of patients under MV in ICU.
