基于eCASH策略对ICU高流量氧疗治疗呼吸衰竭患者的临床应用效果分析

Clinical Application of eCASH Strategy in the High Flow Oxygen Therapy of Patients with Respiratory Failure in ICU

目的:本文旨在研究舒适化浅镇静(eCASH)策略在呼吸衰竭患者高流量氧疗中的应用,并对比右美托咪定和咪达唑仑的治疗效果。方法:将进行高流量吸氧治疗的90例呼吸衰竭患者随机分为3个组:对照组(不予镇静治疗),右美组予负荷剂量为1μg/kg,以0.2～0.8μg/(kg·h)持续静脉泵入,咪达组予负荷剂量为0.06mg/kg,以0.04～0.06mg/(kg·h)持续静脉泵入。记录用药前后血流动力学变化情况,比较三组的镇静达标时间、停药后清醒时间、ICU停留时间、谵妄发生率、转机械通气治疗率和不良事件(如血压降低、心动过缓、低氧血症等)发生率。结果:(1)与对照组相比,右美组和咪达组心率、呼吸频率和平均动脉压在用药后明显下降(P<0.05),其中咪达组变化幅度明显大于右美组(P<0.05);(2)咪达组的镇静达标时间明显短于右美组,但右美组停药后清醒时间明显短于咪达组(P<0.05);(3)右美组和咪达组患者的ICU停留时间和转机械通气治疗率明显小于对照组(P<0.05);(4)与其他两组相比,右美组可以明显降低谵妄发生率(P<0.05);(5)咪达组的不良事件发生率明显高于右美组和对照组(P<0.05)。结论:以右美托咪定为主导的eCASH不仅有利于高流量氧疗治疗呼吸衰竭患者的镇静效果,还可以较快协助改善血流动力学状况、减少ICU停留时间、降低谵妄和其它不良事件发生率。

Objective:To explore the application of early comfort using analgesia,minimal sedatives and maximal humane care(eCASH)in the high flow oxygen therapy of patients with respiratory failure and to compare the therapeutic effects of dexmetoimidine(Dex)and midazolam(MDZL).Methods:Ninety patients with respiratory failure who needed high flow oxygen therapy were randomly divided into three groups:Control group with no sedative treatment,Dex group with 1μg/kg loading dose and continuous intravenous infusion at 0.2~0.8μg/(kg·h),and MDZL group with 0.06 mg/kg loading dose and continuous intravenous infusion at 0.04~0.06 mg/(kg·h).The hemodynamic changes before and after treatment were recorded.The sedative standard time,the wake time after the withdrawal,the duration of the ICU,the incidence of delirium,the rate of transferring into mechanical ventilation and incidence of adverse events were all compared among three groups.Results:(1)Compared with the control group,the heart rate(HR),respiratory rate(RR),mean arterial pressure(MAP)in Dex group and MDZL group were significantly decreased after the treatment(all P<0.05).The change amplitude of MDZL group was significantly greater than that of Dex group(P<0.05).(2)The sedative standard time of MDZL group was significantly shorter than that of Dex group,but the wake time of Dex group was significantly shorter than that of MDZL group(both P<0.05).(3)The ICU duration and mechanical ventilation rate of the patients in the Dex and MDZL group were significantly lower than those in the control group(all P<0.05).(4)Compared with the other two groups,Dex significantly reduced the incidence of delirium(P<0.05).(5)The incidence of adverse events in MDZL group was significantly higher than that in Dex group and the control group(P<0.05).Conclusion:eCASH with dexmetomidine is not only beneficial to the sedation effect of high flow oxygen therapy in patients with respiratory failure,but also helps to improve hemodynamics,reduces the residence time of ICU,and decreases the incidence of delirium and the other adverse events.