镇静与镇痛在ICU机械通气患者中的应用变化

探讨ICU内机械通气患者应用镇痛剂、镇静剂及肌松剂的情况及其对机械通气和预后的影响。回顾性分析我院中心ICU2006年、2007年收治的244例行有创机械通气治疗超过48h患者的临床资料，并将患者分为2006年组和2007年纽，用统计软件分析患者在年龄、性别、入ICU时APACHEⅡ评分、血糖、血浆白蛋白、基础疾病，气管插管时间、机械通气时间、ICU住院天数、镇痛与镇静剂应用的时间、机械通气时是否使用肌松剂、Ramsay评分及病死率方面是否存在差别。统计分析显示2006年组和2007年组在年龄、性剐、入ICU时APACHEⅡ评分、血糖、血浆白蛋白、是否使用肌松剂及基础疾病方面无差别；与2006年组相比2007年组患者气管插管时间、机械通气时间及ICU住院天数均缩短，镇痛与镇静剂应用时间均缩短，Ramsay评分降低，病死率下降。提示对机械通气的危重症患者应合理使用镇痛剂与镇静剂。

Analyse the Use of Analgesics and Sedatives in Mechanical Ventilated Patients in ICU

To explore the use of analgesics and sedatives and their effect on mechanical ventilation and prognosis in mechanical ventilated patients in ICU. We conducted a retrospective study in 244 patients receiving mechanical ventilation over 48 hours from 2006 to 2007 in our ICU. All the patients were divided into two groups： 2006 group and 2007 group. We collected the related clinical data as follows： age, gender, conditions on admission to ICU including APACHE Ⅱ （Acute Physiology and Chronic Health Evaluation Ⅱ, APACHE Ⅱ ）, blood glucose, plasma--albumin as well as basic diseases, the duration of intubation and mechanical ventilation, the length of ICU stay, the time of analgesia and sedation, use of neuromuscular blocking agents, Ramsay score and mortality. There was no statistic difference between the two groups in age, gender, APACHE Ⅱ , blood glucose, plasma--albumin, use of neuromuscular blocking agents and basic diseases; Compared with 2006 group, in 2007 group, the duration of intubation, mechanical ventilation and the length of ICU stay were shortened respectively, and the time of analgesia, sedation and use of neuromuscular blocking agents were decreased, as well as Ramsay score and mortality. We should pay closer attention to rational use of analgesics and sedatives in critically ill patients treated with mechanical ventilation.