| Objective: To describe the nurses' sedation related knowledge and its influencing factors in patients with mechanical ventilation in the department of critical care medicine of Affiliated Hospital of Guizhou medical university(Intensive Care Unit,ICU);To evaluate the effect of sedation score on mechanical ventilation time,ICU treatment time,total hospital stay,the total amount of sedative drugs and the incidence of delirium in patients after sedation care combined with using sedation scoring instrument.Methods: This study was divided into two parts.1.The first part of the questionnaire stages: take convenient sampling,issued 150 copies of ICU nurses to the Affiliated Hospital of Guizhou Medical University to investigate nurses knowledge of sedation in patients with mechanical ventilation status questionnaire.2.The second part of clinical intervention: Using a randomized controlled study method,according to the entry order number,All 100 patients with ICU continuous sedation mechanical ventilation in the Affiliated Hospital of Guizhou Medical University were divided into 2 groups,each group with a total of 50 cases,odd numbers as experimental group,even numbers as control group from December 2015 –June 2016.Patients in the control group were treated with conventional sedation therapy,that is,the nurse executes and adjusts the sedative pump speed according to the doctor's advice,Patients in the experimental group on the basis of the existing sedative treatment by the researchers on the application of the nurse sedation exchange scoring tool(Nursing Instrument for the Communication of Sedation,NICS)and the Bispectral index(Bispectral index,BIS)for sedation assessment.Once per hour.Inform the doctor and take preventive measures according to the evaluation results,(such as adjusting the uncomfortable position,reducing the sound and light stimulation,etc).After the treatment is invalid,adjust the rate of infusion of sedative drugs.The sedative effect and adverse events were compared between the two groups.Results: 1.A total of 146 questionnaires were collected,the effective rate was 97.3%.2.The main way of sedative drug delivery is continuous intravenous infusion,accounting for 94.5%;The restless sedation score(Richmonad agitation-sedation scale,RASS)was the highest usage,about 53.4%.The second was Ramsay Sedation score(Ramsay Sedation Scale,RSS),accounting for 34.9%.The sedation anxiety score(Sedation-Agitation Scale,SAS)was 7.5%,6.8% of the nurses did not use any sedation assessment tools,often rely on work experience to manage the treatment of critically patients with sedation;58.9% the sedation evaluator was a nurse and the 33.6% was a physician.3.In this survey,89% of nurses believe that they will be able to become the evaluator and manager of sedation in the future,hoping to get further learning opportunities.4.Compared the patients with mechanical ventilation time,ICU treatment time,total hospitalization time,the total amount of sedative drugs of the intervention group between the control group,the difference was statistically significant(p< 0.05): The total amount of Midazolam Injection in the experimental group was(237.3 ± 90.3)ml,which was lower than that of the control group(356.7± 97.3)ml;The total amount of Propofol Injection in the experimental group was(2582.2+313.0)ml,which was lower than that of the control group(2758.4+306.3)ml;The treatment time of ICU in the experimental group was(6.19+2.23)days lower than that of the control group(9.35+3.47)days.The total length of hospital stay in the experimental group was(14.0+4.92)days was lower than that in the control group(16.1+4.30)days;The mechanical ventilation time of the experimental group was(5.58+1.75)days lower than that of the control group(7.84+3.25)days.There was no significant difference in the incidence of delirium during sedation between the two groups(p>0.05).Conclusion: 1.The relevant knowledge of sedation in mechanically ventilated patients of Nurses in ICU of Affiliated Hospital of Guizhou Medical University with severe Society of Critical Care Medicine understand the 2013 edition of the guide there is still a gap,to further improve the standardized training of nurses will be the key to improve the therapeutic effect of sedation and the level of sedation and care 2.Combined use of NICS and BIS to evaluate the mechanical ventilation in patients with mechanical ventilation than conventional sedation treatment can reduce the mechanical ventilation time,reduce the total dose of sedative drugs,shorten the ICU treatment time and total hospital stay,improved patient outcomes for sedation. |
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