Effect Evaluation Patients Of Ecash Sedation And Analgesia Strategy In ICU

Objective: early comfort using anesthesia,minimal sedatives and maximal human care(eCASH)sedation and analgesia strategy is to replace shallow sedation goal with comfortable feeling,and replace full analgesia with effective analgesia and humanistic care doctor-patient interaction,so as to compare its advantages with early goal directed sedation(EGDS),and analyze the factors affecting clinical efficacy,To provide better analgesic and sedative strategies for patients in intensive care unit(ICU).Methods: 1.A prospective cohort study was conducted on 116 patients admitted to ICU in the First Affiliated Hospital of University of South China from August 2019 to December 2019.According to continuous intravenous infusion of fentanyl or patient self-control + local nerve block or spinal anesthesia,51 patients were included in eCASH group;Dexmedetomidine combined with fentanyl was continuously pumped intravenously,and the drug dosage was adjusted according to the severity of the patient’s condition and agitation,so as to achieve the goal of shallow sedation-2～1 as soon as possible.56 cases were included in the EGDS group.2.The patient’s name,gender,age,weight,disease type,complications,APACHE-II score,SOFA score,ALB,alt,AST,child Pugh grade,use rate of analgesic and sedative drugs,dose,use time,number of people who reach the standard of sedation per day,rate of reaching the standard,number and incidence of delirium,ICU hospitalization / total hospitalization time and ICU / total cost,night sleep time,ventilator offline time and medical cost-benefit analysis were collected,And analyze the factors affecting the curative effect of patients.Results: 1 The analgesic effect of eCASH and EGDS groups has reached the standard,and the dosage of butorphanol can be reduced in ecash group(P = 0.109).2.There was no significant increase or decrease in the incidence of delirium between eCASH group and EGDS group(Z = 0.016,P = 0.900)compared with the days without delirium(P = 0.396).3.Analysis within mechanical ventilation group: 1)no matter whether mechanical ventilation or not,the incidence of delirium in eCASH group was not significantly higher or lower than that in EGDS group(P = 0.277,P = 0.206).In the non mechanical ventilation group,the use rates of sedatives and dexmedetomidine in eCASH group were lower than those in EGDS group(P = 0.000);However,in the non mechanical ventilation group,the use rate of analgesic drugs and Butorphanol in eCASH group were higher than that in EGDS group(P =0.000).In the mechanical ventilation group,the cumulative dose of butofenol per kilogram in eCASH group was lower than that in EGDS group(P = 0.004);Secondly,the use rate of dexmedetomidine and the cumulative dose of propofol per kilogram in eCASH group were lower than those in EGDS group(P = 0.021).2)There was no significant increase or decrease in RASS score compliance rate within 7 days after admission in non mechanical ventilation and mechanical ventilation groups(P > 0.05).In each group,there was no significant difference in the composition of daily RASS score between EGDS group and eCASH group(all P > 0.05).Conclusion:1.Compared with EGDS strategy,eCASH analgesic sedation strategy used in this study can reduce the dose and utilization rate of analgesic drugs,especially in patients with mechanical ventilation;Compared with EGDS group,it did not increase the incidence of delirium.It may be related to diversified non drug treatment,and some ICU patients may not need sedation intervention.2.eCASH sedation can reduce the use of sedative and analgesic drugs in severe patients,has obvious social benefits,and can reduce iatrogenic addiction and adverse effects on society.eCASH sedative and analgesic strategy significantly reduces the abuse of sedative and analgesic drugs in clinical ICU,and greatly reduces the consequent social problems such as addiction,which has obvious social benefits.3.Compared with EGDS sedation and analgesia,eCASH sedation and analgesia can not effectively reduce the length of stay and expenses in ICU.The reason may be that the two strategies,as commonly used and mature sedation and analgesia strategies,have similar clinical application effects.In the follow-up,it can be considered to add blank control and follow-up of family satisfaction to further analyze the advantages of ecash sedation and analgesia.