2018 年第 2 期 第 13 卷

心脏外科围术期体外膜氧合辅助患者目标浅镇静的效果和安全性

作者：王红李呈龙田夏秋杨晓宇杜中涛江春景谢海秀刘楠贾明侯晓彤

英文作者：

单位：100029首都医科大学附属北京安贞医院心脏外科危重症中心北京市心肺血管疾病研究所（王红、李呈龙、田夏秋、杜中涛、江春景、谢海秀、刘楠、贾明、侯晓彤）；100015首都医科大学附属北京地坛医院新发突发传染病北京重点实验室（杨晓宇）

英文单位：

关键词：体外膜氧合；镇静；Richmond镇静程度评估表；严重心律失常

英文关键词：

• 摘要：

• 目的    初步探讨心脏手术围术期体外膜氧合（ECMO）辅助患者，ECMO开始12～24 h后或经过低温治疗已完成复温之后的维持阶段，在充分镇痛基础上行目标浅镇静的效果和安全性。方法    回顾分析2016年1—12月应用ECMO辅助的心脏手术围术期心肺功能衰竭的84例成人患者数据，排除24 h内死亡17例，神志不清不能恢复17例，共50例患者实施以Richmond镇静程度评估表（RASS）评分-2～0分为目标的浅镇静策略，纳入研究。分析比对相关有效性及安全性指标。结果    躁动或谵妄的发生率为26.0%（13/50）。采用浅镇静策略后，全部患者的肾替代治疗、感染、下肢缺血事件以及ECMO转机时间、住重症监护病房时间、住院时间等与既往本中心采用目标深镇静时的报道值接近，发生躁动或谵妄的患者与持续RASS评分≤0分且无谵妄的患者比较，严重心律失常发生率较高［69.2%（9/13）比35.1%（13/37）］，差异有统计学意义（P=0.03）。结论    心脏手术围术期ECMO辅助患者可能需要目标更深的镇静，随病情变化而制定的个体化镇静策略可能更对患者有益。

• Effect and safety of targeted light sedation on cardiac surgery patients undergoing perioperative extracorporeal membrane oxygenation

  Wang Hong, Li Chenglong, Tian Xiaqiu, Yang Xiaoyu, Du Zhongtao, Jiang Chunjing, Xie Haixiu, Liu Nan, Jia Ming, Hou Xiaotong

  Emergency and Critical Care Center, Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing 100029, China(Wang H, Li CL, Tian XQ, Du ZT, Jiang CJ, Xie HX, Liu N, Jia M, Hou XT); Beijing Key Laboratory of Emerging Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China(Yang XY)

  Corresponding author: Hou Xiaotong, Email: houxiaotong_2013@163.com

  【Abstract】Objective    To investigate the effect and safety of targeted light sedation based on adequate analgesia for perioperative extracorporeal membrane oxygenation(ECMO) supported cardiac surgery patients who had been treated with ECMO for 12-24 h or completed rewarming phase after therapeutic hypothermia. Methods    Eighty-four adult cardiac surgery patients who had ECMO during perioperative period were reviewed from January 2016 to December 2016. Seventeen cases who died within 24 h and 17 cases of unconsciousness were excluded, 50 cases had targeted light sedation based on the Richmond Agitation-Sedation Scale(RASS) score －2-0. Indicators of effectiveness and safety were analyzed. Results    Incidence of agitation or delirium was 26.0%(13/50). Incidences of renal replacement therapy, infection, lower limb ischemia, ECMO time, intensive care unit stay time and hospital stay time of targeted light sedation were close to those of targeted deep sedation at our center. Patients with agitation or delirium had a higher incidence of serious arrhythmia compared to patients with the RASS score≤0 and without delirium［69.2%（9/13） vs 35.1%（13/37）］, the difference was statistically significant(P=0.03). Conclusion    Cardiac surgery patients with perioperative ECMO may need deeper sedation, and personalized sedative strategies may be more beneficial.

  【Key words】Extracorporeal membrane oxygenation;Sedation;Richmond Agitation-Sedation Scale;Serious arrhythmia

  【Fund program】National Key Research and Development Program（2016YFC1301001）