eCASH理念对心血管外科术后患者谵妄和应激指标的影响  

Effects of eCASH concept on delirium and stress indexes in patients after cardiovascular surgery

作　　者：李艳[1] 何茂鑫[1] 刘英培 王军涛[2] Yan LI;Mao-Xin HE;Ying-Pei LIU;Jun-Tao WANG(Department of Cardiovascular Surgery,First People's Hospital of Shangqiu,Shangqiu 476005,Henan Province,China;Department of Moist Immunology,First People's Hospital of Shangqiu,Shangqiu 476005,Henan Province,China)

机构地区：[1]商丘市第一人民医院心血管外科,河南商丘476005 [2]商丘市第一人民医院风湿免疫科,河南商丘476005

出　　处：《数理医药学杂志》2023年第3期194-200,共7页Journal of Mathematical Medicine

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20191505)。

摘　　要：目的观察早期以患者为中心的舒适化浅镇静(early comfort using analgesia,minimal sedatives and maximal humane care,eCASH)理念对心血管外科术后患者谵妄及不良事件的影响。方法选取商丘市第一人民医院2019年10月至2022年10月94例行心血管外科手术的患者作为研究对象,分为常规组和eCASH干预组各47例。比较两组术后谵妄情况、应激指标P物质(substance P,SP)、前列腺素E2(prostaglandin E2,PGE2)及谵妄引发的不良事件、恢复情况。结果eCASH组谵妄发生率低于常规组(10.64%vs.29.79%,P=0.021),谵妄持续时间(2.47±1.32 vs.4.02±1.15,P<0.001)短于常规组;术后3 d eCASH组血清SP(6.42±1.28 vs.9.65±2.33,P<0.001)、PGE2(112.56±23.21 vs.140.26±18.32,P<0.001)水平均低于常规组;eCASH组总不良事件发生率低于常规组,且机械通气时间、ICU停留时间、卧床时间、住院时间均短于常规组(P<0.05)。结论eCASH理念可能可缓解心血管外科术后患者谵妄及不良事件,改善应激状态。Objective To observe the effects of early comfort using analgesia,minimal sedatives and maximal humane care(eCASH)on postoperative delirium and adverse events in patients undergoing cardiovascular surgery.Methods A total of 94 patients undergoing cardiovascular surgery in the First People's Hospital of Shangqiu from October 2019 to October 2022 were randomly divided into conventional group and eCASH intervention group 47 patients in each group.Postoperative delirium,stress indexes substance P(SP),prostaglandin E2(PGE2)and delirium-included adverse events,and recovery were compared between the two groups.Results The incidence of delirium in the eCASH intervention group was lower than that in the conventional group(10.64%vs.29.79%,P=0.021),and the duration of delirium was shorter than that in the conventional group(2.47±1.23 vs.4.02±1.15,P<0.001).The serum levels of SP(6.42±1.28 vs.9.65±2.33,P<0.001)and PGE2(112.56±23.21 vs.140.26±18.32,P<0.001)in the eCASH intervention group 3 days after surgery were lower than those in the conventional group.The incidence of total adverse events in the eCASH intervention group was lower than that in the conventional group,and the duration of mechanical ventilation,ICU stay,bed rest and hospital stay were shorter than those in the conventional group(P<0.05).Conclusion eCASH may effectively reduce delirium and adverse events in patients after cardiovascular surgery,and improve stress state.

关 键 词：心血管外科术 谵妄 舒适化浅镇静 不良事件 

分 类 号：R654.2[医药卫生—外科学]