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新型冠状病毒2型(SARS-CoV-2)感染患者体外膜肺氧合(VV-ECMO)治疗期间的镇静、镇痛和肌肉松弛:一项单中心、回顾性、观察性研究

Sedation, Analgesia, and Muscle Relaxation During VV-ECMO Therapy in Patients With Severe Acute Respiratory Syndrome Coronavirus Type 2 (SARS-CoV-2): A Single-Center, Retrospective, Observational Study.

作者信息

Wu Fang, Li Mingna, Zhang Zhongwei, Shang Jiawei, Guo Yong, Li Yingchuan

机构信息

Department of Critical Care Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.

Department of Critical Care Medicine, Tongji University Affiliated Shanghai Tenth People's Hospital, Shanghai, China.

出版信息

Front Med (Lausanne). 2021 Dec 17;8:762740. doi: 10.3389/fmed.2021.762740. eCollection 2021.

Abstract

The pharmacokinetics and pharmacodynamics of ECMO-supported sedative, analgesic, and muscle relaxants have changed, but there are insufficient data to determine the optimal dosing strategies for these agents. Sedation, analgesia and muscle relaxation therapy for patients with severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) receiving ECMO support are more specific and have not been fully reported. This study observed and evaluated the use of sedative and analgesic drugs and muscle relaxants in SARS-CoV-2 patients treated with VV-ECMO. This study was a single-center, retrospective and observational study. Our study includes 8 SARS-CoV-2 patients treated with VV-ECMO in an intensive care unit at Shanghai Public Health Center from February to June 2020. We collected the demographic data from these patients and the dose and course of sedation, analgesia, and muscle relaxants administered during ECMO treatment. The doses of sedative, analgesic and muscle relaxant drugs used in patients with VV-ECMO were significant. Over time, the doses of drugs that were used were increased, and the course of muscle relaxant treatment was extended. Sedation, analgesia, and muscle relaxant use require individualized titration in patients with SARS-CoV-2 who have respiratory failure and who are receiving VV-ECMO.

摘要

体外膜肺氧合(ECMO)支持下镇静、镇痛和肌肉松弛药物的药代动力学和药效学已发生变化,但尚无足够数据来确定这些药物的最佳给药策略。对于接受ECMO支持的新型严重急性呼吸综合征冠状病毒2(SARS-CoV-2)患者,镇静、镇痛和肌肉松弛治疗更具特殊性,且尚未得到充分报道。本研究观察并评估了接受静脉-静脉体外膜肺氧合(VV-ECMO)治疗的SARS-CoV-2患者使用镇静和镇痛药物以及肌肉松弛剂的情况。本研究为单中心回顾性观察性研究。我们的研究纳入了2020年2月至6月在上海公共卫生临床中心重症监护病房接受VV-ECMO治疗的8例SARS-CoV-2患者。我们收集了这些患者的人口统计学数据以及ECMO治疗期间给予的镇静、镇痛和肌肉松弛剂的剂量及疗程。接受VV-ECMO治疗的患者使用镇静、镇痛和肌肉松弛药物的剂量差异显著。随着时间推移,所用药物剂量增加,肌肉松弛剂治疗疗程延长。对于呼吸衰竭且接受VV-ECMO治疗的SARS-CoV-2患者,镇静、镇痛和肌肉松弛剂的使用需要个体化滴定。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7586/8718548/9a3b8bd816a1/fmed-08-762740-g0001.jpg

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