成人体外膜肺氧合镇痛镇静管理方案的构建及应用效果研究

doi:10.3761/j.issn.2096-7446.2025.08.001

摘要/Abstract

摘要：

目的构建成人应用体外膜肺氧合（extracorporeal membrane oxygenation，ECMO）的镇痛镇静管理方案，避免镇痛镇静药物蓄积和不充分的镇痛镇静，减少不良事件发生，优化ECMO支持。方法检索国内外文献，获取最佳实践证据，构建成人ECMO镇痛镇静管理方案初稿。2024年3月—5月，运用德尔菲法对16名专家进行2轮咨询，形成成人ECMO镇痛镇静管理方案终稿。采用便利抽样法选取2024年7月—9月深圳市某三级甲等医院重症医学科ECMO患者进行初步应用，应用重症监护疼痛观察量表（Critical-Care Pain Observation Tool，CPOT）和Richmond躁动-镇静评分（Richmond Agitation and Sedation Scale，RASS）评估量表评价该方案应用后患者镇痛镇静的效果。结果 2轮专家咨询的问卷回收率分别为88.9%和100%，专家权威系数为0.862，肯德尔和谐系数为0.184和0.204（均P<0.001）。最终构建的成人ECMO镇痛镇静管理方案包括5个一级指标（评估工具、镇痛镇静目标、药物选择、药物滴定、监测）、11个二级指标及24个三级指标。该方案应用后CPOT评分<3分，患者没有产生疼痛的不良刺激，RASS评分为-3~1分，患者没有出现镇静不足或镇静过度，能够维持合适的镇静水平。结论该研究构建的成人应用ECMO镇痛镇静管理方案全面、具体，具有科学性和可行性，可为成人ECMO镇痛镇静管理提供参考。

关键词: 体外膜肺氧合, 成人患者, 镇痛镇静, 德尔菲法, 危重病护理

Abstract:

Objective This study aims to construct an analgesia and sedation management program for adult patients undergoing extracorporeal membrane oxygenation（ECMO） therapy in order to prevent the accumulation of analgesics and sedatives，avoid inadequate analgesia and sedation，reduce adverse events，and optimize ECMO support. Methods By searching domestic and foreign literature，obtaining best practice evidence，we constructed the first draft of an adult extracorporeal membrane oxygenation analgesia and sedation management program. From March to May 2024，16 experts were consulted for 2 rounds using the Delphi method to form the final draft of the adult ECMO analgesia and sedation management program. Convenience sampling method was used to select ECMO patients from the critical care medicine department of a tertiary A hospital in Shenzhen from July to September 2024 for preliminary application. The Critical-Care Pain Observation Tool（CPOT） and the Richmond Agitation and Sedation Scale（RASS） evaluation scales were used to evaluate the analgesia and sedation effect of the patients after application of the program. Results The effective questionnaire recovery rate for the two rounds of Delphi consultation were 88.9% and 100%，respectively. The expert authority coefficient was 0.862 and Kendall’s coordination coefficient was 0.069 and 0.085（both P<0. 001）. The sedation and analgesia management program in ECMO therapy for adult patients was finally formed，including 5 primary indicators（assessment tools，analgesia and sedation goals，drug selection，drug titration，monitoring），11 secondary indicators，and 24 tertiary indicators. After application of this program，the CPOT score was <3 points，the patient had no adverse stimulation that caused by pain，and the RASS score was -3 to 1. The patient did not experience insufficient or excessive sedation，and an appropriate level of sedation was maintained. Conclusion The adult ECMO analgesia and sedation management program constructed in this study is comprehensive，specific，scientific and feasible，and can provide reference for adult ECMO analgesia and sedation management.

Key words: Extracorporeal Membrane Oxygenation, Adult Patients, Analgesia and Sedation, Delphi Method, Critical Care Nursing

刘宇亭, 祁梦莹, 蒙斯雅, 王冰寒, 王乔莎, 何桂兰. 成人体外膜肺氧合镇痛镇静管理方案的构建及应用效果研究[J]. 中华急危重症护理杂志, 2025, 6(8): 901-907.

LIU Yuting, QI Mengying, MENG Siya, WANG Binghan, WANG Qiaosha, HE Guilan. Construction and application effects of an analgesia and sedation management program for adult patients undergoing extracorporeal membrane oxygenation therapy[J]. Chinese Journal of Emergency and Critical Care Nursing, 2025, 6(8): 901-907.

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