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.

1.Migirov A, Chahar P, Maheshwari K. Postoperative delirium and neurocognitive disorders[J]. Curr Opin Crit Care, 2021, 27(6): 686-693. DOI: 10.1097/MCC.0000000000000882.

2.Jin Z, Hu J, Ma D. Postoperative delirium: perioperative assessment, risk reduction, and management[J]. Br J Anaesth, 2020, 125(4): 492-504. DOI: 10.1016/j.bja.2020.06.063.

3.洪亮, 孙加奎, 沈骁, 等. 心脏手术后谵妄的危险因素分析及预测模型构建[J]. 临床麻醉学杂志, 2020, 36(12): 1195-1200. [Hong L, Sun JK, Shen X, et al. Risk factors analysis and prediction model construction of postoperative delirium after cardiac sur-gery[J]. Journal of Clinical Anesthesiology, 2020, 36(12): 1195-1200.] DOI: 10.12089/jca.2020.12.012.

4.王维, 陶琳, 马延超, 等. eCASH护理模式在冠心病PCI术患者中的应用效果[J]. 中华现代护理杂志, 2022, 28(3): 366-370. [Wang W, Tao L, Ma YC, et al. Application effect of eCASH nursing model in patients undergoing PCI surgery for coronary heart disease[J]. Chinese Journal of Modern Nursing, 2022, 28(3): 366-370.] DOI: 10.3760/cma.j.cn115682-20210604-02430.

5.周丹, 杨青敏, 唐建国, 等. 基于eCASH理念的舒适化浅镇静方案在机械通气患者中的应用效果研究[J]. 护士进修杂志, 2020, 35(11):1033-1036. [Zhou D, Yang QM, Tang JG, et al. Study on the application effect of Com-fortable shallow sedation program in patients with mechanical ventilation based on eCASH concept[J]. Journal of Nurses Training, 2020, 35(11):1033-1036.] DOI: 10.16821/j.cnki.hsjx.2020.11.017.

6.中国心血管病风险评估和管理指南编写联合委员会. 中国心血管病风险评估和管理指南[J]. 中华预防医学杂志, 2019, 53(1): 13-35. [China Joint Committee for the Compilation of Guidelines for Cardiovascular Disease Risk Assessment and Management. Guideline on the assessment and management of cardiovascular risk in China[J]. Chinese Journal of Preventive Medicine, 2019, 53(1): 13-35.] DOI: 10.3760/cma.j.issn.0253-9624.2019.01.004.

7.赵以林, 罗爱林. 2018版美国麻醉医师协会适度镇静和镇痛指南解读[J]. 临床外科杂志, 2019, 27(1): 24-28. [Zhao YL, Luo AL. Interpretation of the 2018 American Society of anesthesiologists guidelines for moderate sedation and analgesia[J]. Journal of Clinical Surgery, 2019, 27(1): 24-28.] DOI: 10.3969/j.issn.1005-6483.2019.01.006.

8.张伟英, 梁珠阳, 陶丽. ICU意识模糊量表与临床直接观察在心脏术后谵妄评估中的差异性研究[J]. 护士进修杂志, 2017, 32(13): 1161-1164. [Zhang WY, Liang ZY, Tao L. The difference of the delirium evaluation between ICU fuzzy scale and clinical direct observation after cardiac surgery[J]. Journal of Nurses Training, 2017, 32(13): 1161-1164.] DOI: 10.16821/j.cnki.hsjx.2017.13.003.

9.Chen H, Mo L, Hu H, et al. Risk factors of postoperative delirium after cardiac surgery: a meta-analysis[J]. J Cardiothorac Surg, 2021, 16(1): 113. DOI: 10.1186/s13019-021-01496-w.

10.李艳艳, 原大江, 李小雅, 等. ICU患者谵妄及谵妄持续时间的危险因素分析[J]. 中华危重病急救医学, 2020, 32(1): 62-66. [Li YY, Yuan DJ, Li XY, et al. Risk factors for delirium in intensive care unit and its duration[J]. Chinese Critical Care Medicine, 2020, 32(1): 62-66.] DOI: 10.3760/cma.j.cn121430-20190909-00011.

11.祝利花, 周敏, 翟晓媛. 心脏外科ICU患者术后谵妄的危险因素研究[J]. 护理学报, 2020, 27(1): 56-61. [Zhu LH, Zhou M, Zhai XY. Risk factors of postoperative delirium in patients in cardiac surgery intensive care unit[J]. Journal of Nursing, 2020, 27(1): 56-61.] DOI: 10.16460/j.issn1008-9969.2020.01.056.

12.熊梅凤, 陈彩花, 庄海燕, 等. eCASH模式对重症连续肾脏替代治疗患者负性情绪及相关不良事件风险的影响[J]. 中国实用护理杂志, 2022, 38(3): 186-191. [Xiong MF, Chen CH, Zhuang HY, et al. The effect of eCASH model on negative emotion and risk of related adverse events in patients with severe continuous renal re-placement therapy[J]. Chin J of Practical Nursing, 2022, 38(3): 186-191.] DOI: 10.3760/cma.j.cn211501-20210430-01280.

13.王霞, 邓娟, 熊杰, 等. 基于故障树理论和eCASH理念的ICU患者镇静镇痛管理策略[J]. 护理学杂志, 2020, 35(4): 39-43. [Wang X, Deng J, Xiong J, et al. Construction and application of ICU sedative and analgesic management strategy based on Fault Tree Theory and eCASH (early comfort using analgesia, minimal sedatives and maximal humane care) concept[J]. Journal of Nursing Science, 2020, 35(4): 39-43.] DOI: 10.3870/j.issn.1001-4152.2020.04.039.

14.商江丽, 李进, 易炜娜, 等. 快速康复护理胸外科术后患者康复效果及并发症发生率的影响研究[J]. 贵州医药, 2020, 44(9): 1486-1487. [Shang JL, Li J, Yi WN, et al. Study on the effect of rapid rehabilitation nursing on the recovery of patients after thoracic surgery and the incidence of complications[J]. Guizhou Medical Journal, 2020, 44(9): 1486-1487.] DOI: 10.3969/j.issn.1000-744X.2020.09.080.

15.王桥生, 罗琼, 蒋志华, 等. 以eCASH理念为基础的镇静策略对ICU患者的效果[J]. 中华急诊医学杂志, 2021, 30(2): 226-230. [Wang QS, Luo Q, Jiang ZH, et al. Effect of eCASH based sedation strategy on ICU patients[J]. Chin J of Emergency Medicine, 2021, 30(2): 226-230.]DOI: 10.3760/cma.j.issn.1671-0282.2021.02.017.

16.杨彦楠, 杨欣刚, 姚钧, 等. eCASH镇痛镇静策略与每日唤醒策略在重症监护病房中的效果比较[J]. 哈尔滨医科大学学报, 2021, 55(2): 165-168. [Yang YN, Yang XG, YAO J, et al. Comparison of the effects of eCASH analgesic and sedative strategies and daily wake-up strategies in intensive care units[J]. Journal of Harbin Medical University, 2021, 55(2): 165-168.] DOI: 10.3969/j.issn.1000-1905.2021.02.014.

17.金蓉, 张艳, 管义祥. eCASH理念应用于ICU机械通气患者中的效果观察[J]. 中华保健医学杂志, 2022, 24(5):405-407. [Jin R, Zhang Y, Guan YX. Observation of the effect of eCASH in ICU mechanical ventilation patients[J]. Chinese Journal of Health Care and Medicine, 2022, 24(5): 405-407.] DOI: 10.3969/j.issn.1674-3245.2022.05.015.