A Comparative Study Of RASS And SAS Scores In The Sedation Of Patients With Invasive Mechanical Ventilation In AECOPD

Objectives To observe and compare the effect of Richmond agitation sedation scale?RASS?and Sedation-Agitation Scale?SAS?in sedation treatment of patients with acute exacerbation of chronic obstructive pulmonary disease,so as to provide a certain clinical basis for the choice of sedation evaluation tools in the treatment of AECOPD.Methods From November 2018 to December 2019,Choosing 80 patients who were hospitalized in the Intensive care unit of the Affiliated Hospital of North China University of science and technology and were definitely diagnosed as AECOPD with invasive mechanical ventilation.They were divided into RASS score group?R group,n=40?and SAS score group?S group,n=40?.RASS score and SAS score were respectively used to guide the sedation treatment of the two groups.The patients in the two groups were given the same kind of analgesic and sedative drugs.On the basis of sufficient analgesia,the sedative strategy of combining daily wake-up with early target directed sedation was implemented with shallow sedation as the target sedation depth.Before continuous sedation?T₀?,1h?T₁?,4h?T₂?,12h?T₃?,24h?T₄?,48h?T₅?after continuous sedation,the vital signs and respiratory dynamic indexes were recorded and compared between the two groups.At the above time points,Arterial blood gas were measured.To record and compare the cardiovascular related adverse events during sedation and the incidence of adverse events during hospitalization in ICU between the two groups.And to record and compare the time of analgesia,sedative dosage,sedation,invasive mechanical ventilation,tracheal intubation and ICU hospitalization between the two groups.Results 1 There was no significant difference in gender,age,acute physiology and chronic health evaluation II and indoor Pa CO₂ between the two groups?P>0.05?.2 In group comparison: HR,MAP,RR,Ppeak,Pplat,PEEPi,Raw and Pa CO₂ were lower than those at T₀,while VT,Cdyn,p H,Pa O₂ were higher than those at T0?P<0.05?.3 There was no significant difference in MAP,HR,RR and Pa CO₂ between the two groups at T₀ and T₁ time?P>0.05?.Map,HR and RR at T₂^T₅ time in R group were higher than those in S group?P<0.05?.Pa CO₂ at T₂^T₅ time in R group was lower than that in S group?P<0.05?.There was no significant difference in Ppeak,Raw and Cdyn at T₀^T₂ time between the two groups?P>0.05?.The Ppeak and Raw of T3^T5 in R group were lower than those in S group,and the Cdyn of T₃^T₅ in R group was higher than that in S group,the difference was statistically significant?P<0.05?.There was no significant difference in Pa O₂,VT,Pplat,PEEPi and p H between the two groups?P>0.05?.4 There was no statistical difference in the incidence of tachycardia,delirium,man-machine confrontation and unplanned extubation between the two groups?P>0.05?,while the incidence of hypotension,bradycardia,ventilator associated pneumonia and deep venous thrombosis in the R group was lower than that in the S group?P<0.05?;The difference was statistically significant?P<0.05?.5 There was no statistical difference in the dosage of analgesic drugs per unit time between the two groups?P>0.05?;The sedative dosage,sedation time,invasive mechanical ventilation time,tracheal intubation retention time and ICU stay time in group R were less than those in group S?P<0.05?.Conclusions For patients with AECOPD undergoing invasive mechanical ventilation,When performing early goal-directed sedation therapy with shallow sedation as the target depth,the use of RASS sedation score to assess the depth of sedation and guide the dosage of sedation drugs can achieve a more favorable sedation state for patients' disease relief,effectively shorten the duration of invasive mechanical ventilation and ICU,and reduce the incidence of some adverse events.And it is worthy of further study and application in future clinical work.Figure 12;Table 17;Reference 171...