美国上腺素缺乏与败血症患者死亡率之间的关联
Emily Vail1, Hayley B Gershengorn2, May Hua3
1Department of Anesthesiology, Columbia University, New York, New York.
JAMA
|March 22, 2017
概括
药物短缺, 像2011年的诺尔上腺素短缺, 与患者死亡率的增加有关. 在短缺期间,烯是常见的替代品,但败血症患者的结果恶化.
科学领域:
- 危急护理医学
- 药理学
- 健康成果研究
背景情况:
- 药物短缺在美国是一个日益严重的问题,
- 药物短缺对患者的临床后果,特别是在重症监护室,仍然没有得到充分报告.
- 上腺素是一种重要的第一线血管压缩剂,
研究的目的:
- 调查2011年全国上腺素短缺对患者护理和结果的影响.
- 评估短缺期间血管压缩剂使用和住院死亡率的变化.
- 为了确定在上腺素稀缺期间使用的替代血管抑制剂.
主要方法:
- 一个回顾性队列研究使用首席医疗数据库.
- 包括26家美国医院,在感染性休克患者中,基线诺亚上腺素使用率至少为60% (n=27,835).
- 通过多级混合效应后勤回归,分析诺拉皮内的使用,替代性血管压缩剂的使用 (主要是烯) 和住院死亡率.
主要成果:
- 在2011年的短缺期间,上腺素的使用量显著下降,而上腺素成为最常见的替代品.
- 与正常使用季度 (35. 9%) 相比,在短缺季度入院的患者的住院死亡率更高.
- 死亡率的绝对风险增加为3. 7%,与短缺期相关的调整后赔率比为1. 15 (P=. 03).
结论:
- 2011年美国医院的上腺素短缺与感染性休克患者的住院死亡率增加有关.
- 烯是主要的替代血管抑制剂,但其使用并没有减轻死亡风险的增加.
- 这些发现强调了药物可用性对严重病情如败血症的患者结果的关键影响.
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