摘要目的 探讨早期无镇静方案在呼吸重症监护病房(RICU)气管插管机械通气患者中的应用价值.方法 采用前瞻性随机对照研究,将2013年8月至2016年1月入住福州肺科医院RICU的70例机械通气患者按照随机数字表法分为两组:观察组35例,实施早期无镇静方案;对照组35例,实施每日中断镇静方案.比较两组的机械通气时间、住RICU时间和总住院时间、RICU病死率和医院内病死率、镇静剂和镇痛剂用量、医疗费用、各种并发症和不良事件发生率,并对比两组机械通气48 h重要器官损害指标及炎症指标.结果 观察组机械通气时间[(7±5)d]、住RICU时间[(9±7)d]、总住院时间[(17±14)d]、咪达唑仑人均剂量[(99±104)mg]、医疗费用[住RICU费用5.3(8.4)元和总住院费用7.2(19.5)元]、呼吸机相关性肺炎发生率(23%,8/35)、气管切开率(14%,5/35)和消化道不良反应发生率(17%,5/35)均低于对照组[机械通气时间(11±9)d、住RICU时间(18±9)d、总住院时间(29±22)d、咪达唑仑人均剂量(482±337)mg、住RICU费用8.8(17.3)万元、总住院费用15.4(23.4)万元、呼吸机相关性肺炎发生率46%(16/35)、气管切开率37%(13/35)、消化道不良反应发生率40%(14/35)],差异有统计学意义(均P<0.05).两组RICU病死率、医院内病死率、非计划拔管等不良事件比较差异均无统计学意义(均P>0.05).两组机械通气48 h心、肝、肾功能损害指标及乳酸、CRP水平比较差异均无统计学意义(均P>0.05).结论 早期无镇静策略可以缩短RICU患者机械通气时间、RICU停留时间和总住院时间,且未增加各种并发症及不良事件的发生风险.

abstractsObjective To study the value of an early ( mechanical ventilation after 24 h ) non-sedation protocol for intubated , mechanically ventilated patients in the respiratory intensive care unit (RICU).Methods Seventy intubated, mechanically ventilated patients were prospectively enrolled and randomly assigned to management with early non-sedation ( intervention group; n =35 ) or with daily interruption of sedation (DIS) (control group; n=35).The duration of mechanical ventilation, length of the RICU and hospital stay , RICU and hospital mortality , drug consumption , RICU and hospitalization expenses , incidence of complications and adverse events and serum levels of vital organ damage and inflammatory markers after mechanical ventilation for 48 h were recorded and compared .Results Patients in the intervention group had a shorter duration of mechanical ventilation than those in the control group [(7 ±5) vs (11 ±9) d, P<0.05] and were discharged from the RICU [(9 ±7) vs (18 ±9) d, P<0.05] and hospital earlier [(17 ±14) vs (29 ±22) d, P<0.05] than those in the control group.The doses of midazolam were significantly lower in the intervention group than in the control group [ ( 99 ±104 ) vs (482 ±337) mg, P<0.05].The RICU and hospitalization expenses were both significantly lower in the intervention group than in the control group [53(84) vs 88(173), 72(195) vs 154(234) thousand CHY, P<0.05 ] .In the intervention group , the occurrence rates of ventilator associated pneumonia ( 23% vs 46%) , tracheotomy ( 14% vs 37%) and gastrointestinal adverse reactions ( 17% vs 40%) were significantly lower than those in the control group ( P<0.05 ) .No differences were recorded in RICU and hospital mortality (P>0.05).The occurrence rates of unplanned extubation and reintubation and the need for CT brain scans were similar in the 2 groups (P>0.05).The levels of cardiac, liver and renal damage markers, lactic acid and C-reactive protein were the same in both groups (P>0.05).Conclusions The early non-sedation protocol decreased the duration of mechanical ventilation and the length of stay in the RICU and hospital , and it did not increase the incidence of complications and adverse events .