医院前 Diltiazem 的有效性和安全性
Ellen Pil1, Matthew Levy1, Timothy Chizmar2
1Johns Hopkins University School of Medicine, Baltimore, Maryland.
Prehospital emergency care
|March 4, 2024
概括
在大多数患有快速心房动的患者中,医院前的diltiazem有效控制心率. 然而,像低血压这样的不良事件在老年患者或血压和心率较低的患者中更有可能发生.
科学领域:
- 紧急医疗 紧急医疗
- 心脏病学 心脏病学
- 药理学 药理学是指药理学的学科.
背景情况:
- 医院前的协议建议diltiazem用于有症状,稳定的患者与快速心房动,以降低心率.
- 作为通道阻塞剂的迪尔蒂亚泽姆 (Diltiazem) 携带低血压和心肌梗塞的风险,可能导致末端器官损伤.
研究的目的:
- 为了评估医院前diltiazem的临床有效性和安全性.
- 为了确定心率控制的好处是否超过不良事件的风险.
主要方法:
- 在2019年1月至2022年3月期间从EMS接受diltiazem的成年患者的回顾性图表审查.
- 分析患者的人口统计,生命体征,diltiazem剂量,以及服用的药物.
- 多变量逻辑回归用于评估临床改善和不良事件 (胸心跳动,低血压).
主要成果:
- 在2254名患者中,63.8%的患者表现出临床改善 (HR<100 bpm或≥20%的降低).
- 3.5%的患者经历了不良事件 (胸心动脉或低血压).
- 老年患者 (>50) 改善的可能性较低;不良事件更常见于基线SBP<140 mmHg,HR <120 bpm,或使用酸甘油.
结论:
- 医院前的diltiazem通常是安全和有效的心率控制在快速心房动.
- 不良事件的危险因素包括较低的基线血压和心率,以及同时使用酸甘.
- 进一步的研究应该探索不良事件与病因学和下游结果的关系.
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