【摘要】 目的了解重症患者镇静剂耐受发生的相关因素,为制订相应的医疗护理措施提供参考依据。方法回顾性收集2017年2月至2021年3月四川大学华西医院372例行镇静镇痛机械通气患者的电子病历资料,根据镇静剂耐受发生情况将其分为耐受组(60例)和非耐受组(312例),采用单因素分析和logistic回归模型探索患者发生镇静剂耐受的相关因素。结果耐受组年龄、急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)评分低于非耐受组,体重指数,饮酒史、反复间断推注者占比高于非耐受组,镇静剂使用时间长于非耐受组,差异有统计学意义(P <0.05)。多因素分析显示,年龄、APACHEⅡ评分、饮酒、镇静剂使用时间、反复间断推注均为镇静剂耐受发生的独立影响因素(P <0.05)。结论对于行镇静镇痛机械通气后易发生镇静剂耐受的患者,临床应重视并制订重症患者镇静药物的使用管理规范,积极采取措施,减少镇静剂耐受的发生,保护患者安全。更多还原

【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 February2017 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 Ⅱscore, 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.更多还原