文章摘要
基于不同RASS评分的镇静方案在脓毒症休克患者中的应用
Application of sedation scheme based on different RASS scores in patients with septic shock
投稿时间：2021-03-03  
DOI：10.3969/j.issn.1000-0399.2022.01.011
中文关键词: RASS评分  镇静  脓毒症休克
英文关键词: RASS score  Sedation strategy  Septic shock
基金项目:新疆维吾尔自治区人民医院科技引进创新项目（项目编号：20170310）
作者单位E-mail
巴音查汗·博然衣 830000 新疆乌鲁木齐 新疆维吾尔自治区人民医院重症医学科  
唐雯 830000 新疆乌鲁木齐 新疆维吾尔自治区人民医院重症医学科  
王志高 830000 新疆乌鲁木齐 新疆维吾尔自治区人民医院重症医学科  
肖东 830000 新疆乌鲁木齐 新疆维吾尔自治区人民医院重症医学科 liuqi7577@sina.com 
摘要点击次数: 1186
全文下载次数: 633
中文摘要:
      目的 探讨不同RASS评分的镇静方案在脓毒症休克患者中的应用效果。方法 选取2019年1月至2021年1月新疆维吾尔自治区人民医院重症医学科收治的82例脓毒症休克患者，依据随机数字表法分为研究组（n=41）及对照组（n=41）。两组患者进入ICU后均给予对症干预，在此基础上参照RASS评分给予对应镇静方案，研究组将RASS评分维持于-3~-4分，对照组将RASS评分维持于0~-2分。统计两组患者镇静前后心肌损伤相关指标[心肌肌钙蛋白I（cTnI）、cTnT、脑钠肽（BNP）]水平、血气指标[动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）]水平、免疫功能相关指标（NK、CD3+、CD4+）、SOFA、APACHEⅡ评分、机械通气时间、ICU入住时间、28天病死率。结果 镇静3天后两组患者cTnI、cTnT、BNP水平较镇静前降低，且研究组低于对照组、差值大于对照组（P<0.05）；镇静3天后两组PaO2水平较镇静前增高，PaCO2水平较镇静前降低，且研究组PaO2水平高于对照组，PaCO2水平低于对照组、差值大于对照组（P<0.05）；干预后两组患者NK水平较干预前降低，CD3+、CD4+水平较干预前增高，且研究组优于对照组、差值大于对照组，差异均有统计学意义（P<0.05）；镇静3天后两组患者SOFA、APACHEⅡ评分较镇静前降低，且研究组低于对照组、差值大于对照组（P<0.05）；研究组机械通气时间、ICU入住时间短于对照组，差异有统计学意义（P<0.05），28天病死率（14.63%）与对照组（19.51%）比较，差异无统计学意义（P>0.05）。结论 脓毒症休克患者镇静干预中将RASS评分维持于-3~-4分可能更利于有效保护心肌，调节血氧状态及机体免疫功能，缩短机械通气和ICU入住时间。
英文摘要:
      Objective To explore the application effect of sedation scheme based on different RASS scores in patients with septic shock.Methods A total of 82 patients with septic shock in People's Hospital of Xinjiang Uygur Autonomous Region from January 2019 to January 2021 were selected and randomly divided into study group (n=41) and control group (n=41). Two groups of patients were given symptomatic intervention after entering ICU, on the basis of which, the corresponding sedation scheme was given according to RASS score. The RASS score of the study group was maintained at -3~-4, while the RASS score of the control group was maintained at 0~-2. The levels of cardiac troponin I (cTnI), cTnT, brain natriuretic peptide (BNP), blood gas index (PaO2、PaCO2), immune function index (NK、CD3+、CD4+), sofa, Apache Ⅱ score, mechanical ventilation time, ICU stay time, 28 day mortality rate were counted before and after sedation.Results After three days of sedation, the levels of cTnI, cTnT and BNP in the two groups were lower than those before sedation, and the difference in the study group was lessobvious than that in the control group (P<0.05).After three days of sedation, the PaO2 level in the two groups was higher than that before sedation, and the PaO2 level in the study group was higher than that in the control group, the PaO2 level was lower than that in the control group, and the difference was greater than that in the control group (P<0.05).After the intervention, the levels of NK in the two groups were lower than those before the intervention, and the levels of CD3+, CD4+ were higher than those before the intervention, and the study group was better than the control group (P<0.05).The scores of sofa and Apache Ⅱ in the two groups were lower than those before sedation, and the scores in the study group were lower than those in the control group (P<0.05). The time of mechanical ventilation and ICU stay in the study group were shorter than those in the control group (P<0.05), and there was no significant difference between the 28 day mortality (14.63%) and the control group (19.51%) (P>0.05).Conclusion Maintaining RASS score between -3 and -4 in sedation intervention for septic shock patients can protect myocardium, regulate blood gas status and immune function, alleviate the patient's condition, and shorten the time of mechanical ventilation and ICU stay.
查看全文   查看/发表评论  下载PDF阅读器
关闭