نوع مقاله : مقاله پژوهشی

نویسندگان

1 استاد مراقبت‌های ویژه، گروه بیهوشی، مرکز تحقیقات بیهوشی و مراقبت های ویژه، دانشگاه علوم پزشکی شیراز، شیراز، ایران

2 دانشیار مراقبت های ویژه ، گروه بیهوشی، مرکز تحقیقات تروما، دانشگاه علوم پزشکی شیراز، شیراز، ایران

3 متخصص بیهوشی، گروه بیهوشی، مرکز تحقیقات بیهوشی و مراقبت های ویژه، دانشگاه علوم پزشکی شیراز، شیراز، ایران

4 دانشیار جراحی مغز و اعصاب، گروه جراحی مغز و اعصاب، مرکز تحقیقات تروما، بیمارستان تروما شهید رجایی، بخش جراحی مغز و اعصاب، دانشگاه علوم پزشکی شیراز، شیراز، ایران

5 دانشیار مراقبت های ویژه، گروه بیهوشی، مرکز تحقیقات بیهوشی و مراقبت های ویژه، دانشگاه علوم پزشکی شیراز، شیراز، ایران

6 دکترای تخصصی آمارزیستی، مرکز تحقیقات بیهوشی و مراقبت های ویژه، دانشگاه علوم پزشکی شیراز، شیراز، ایران

7 کارشناسی پرستاری، بیمارستان شهید رجایی، دانشگاه علوم پزشکی شیراز، شیراز، ایران

چکیده

مقدمه: سوءمصرف مواد از مشکلاتی است که می‌تواند به کنترل نامناسب درد، بی‌قراری و هذیان منجر شود. در مطالعه‌ی حاضر، تأثیر اجرای یک پروتکل در کنترل علائم محرومیت، درد، بی‌قراری و دلیریوم را بر بیماران مبتلا به سوءمصرف مواد در بخش مراقبت‌های ویژه بررسی می‌کنیم.
روش‌ها: در این مطالعه‌ی تجربی، 44 بیمار (هجده سال و بالاتر) وابسته به اپیوئید مطالعه شدند. درد و آرام‌بخشی در هر ساعت توسط مقیاس رفتاری درد و Richmond Agitation Sedation و دلیریوم هر هشت ساعت توسط Method-Confusion Assessment ارزیابی شدند و باتوجه‌به نمره‌ی به‌دست‌آمده، درمان بر اساس پروتکل دریافت شد. بر اساس نوع، دوز مخدر و نحوه‌ی استفاده محاسبه‌ی دوز متادون انجام شد. علائم احتمالی سندرم محرومیت و مصرف بیش‌ازحد هر ساعت توسط پرستار بخش ارزیابی می‌شد.
یافته‌ها: مدت اقامت در بخش مراقبت ویژه در گروه شاهد، هفده روز و در گروه مداخله هفت روز بود. بیماران در گروه مداخله، در مقایسه با گروه شاهد دوزهای پایین‌تری از متادون و پروپوفول در طول 72 ساعت اول بستری و فنتانیل کمتری بعد از 48 و 72 ساعت دریافت کردند  (p<0.05). در گروه مداخله بیمارانی که در محدوده‌ی قابل‌ قبول درد و بی‌قراری قرار داشتند، بیشتر از گروه شاهد بودند p=0.001) و p=0.05).
نتیجه‌گیری: تشخیص علائم محرومیت، درد، بی‌قراری و دلیریوم در بیماران با سوءمصرف مواد همراه با درمان مناسب و به‌موقع می‌تواند در بهبود مراقبت‌های پزشکی مفید باشد.

کلیدواژه‌ها

عنوان مقاله [English]

The Effect of Implementing Pain, Agitation, and Delirium Control Protocol on Outcomes of Critically Ill Patients with a History of Drug Abuse in Intensive Care Units

نویسندگان [English]

  • Farid Zand 1
  • Golnar Sabetian Jahromi 2
  • Bita Hojatpanah Montazeri 3
  • Hosseinali Khlaili 4
  • Mansour Masjedi 5
  • Naeimeh Assadat Asmarian 6
  • Fateme Safari 7
  • Atefe Moradi 7

1 Professor of Critical Care Medicine, Department of Anesthesiology, Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

2 Associate Professor of Critical Care Medicine, Department of Anesthesiology, Trauma Research Center, Shahid Rajaee (Emtiaz) Hospital, Shiraz University of Medical Sciences, Shiraz, Iran

3 Anesthesiologist, Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

4 Associate Professor of Neurosurgery, Department of Neurosurgery, Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran

5 Associate Professor of Critical Care Medicine, Department of Anesthesiology, Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

6 PhD of Biostatistics, Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

7 MSc of nursing, Shahid Rajaee (Emtiaz) Hospital, Shiraz University of Medical Sciences, Shiraz, Iran

چکیده [English]

Introduction: Drug abuse is a major concern, leading to inappropriate control of pain, agitation, and delirium. In the current study, we aimed to evaluate the effect of implementing Pain, Agitation, and Delirium (PAD) control protocol on the outcomes of critically ill patients with a history of drug abuse in the intensive care unit (ICU).
Methods: In this experimental study, 44 opioid-dependent patients (18 years and older) were included. The pain was assessed by the Behavioral Pain Scale (BPS) per hour, the level of sedation was evaluated by the Richmond Agitation Sedation (RASS) per hour, and Delirium was measured every 8 hours by the Confusion Assessment Method (CAM-ICU). Based on the type and dose of the consumed drug and the way it was used, the dose of methadone was calculated. In addition, possible symptoms of withdrawal syndrome and excessive use were assessed every hour by the intensive care unit nurse.
Results: The ICU stay length was 17 days in the control group and seven days in the intervention group. Patients in the intervention group received lower doses of Methadone and Propofol compared to the control group during 72 hours and lower doses of fentanyl after 48 and 72 hours (p<0.05). In addition, patients with acceptable limits of pain and sedation were significantly more in quantity in the intervention group compared to the control group (p=0.001 and p=0.05, respectively).
Conclusion: Implementing PAD protocol, along with appropriate medical therapy, can greatly help improve the medical care provided by the ICU team. 

کلیدواژه‌ها [English]

  • Agitation
  • Delirium
  • Intensive care unit (ICU)
  • Opium
  • Pain
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