应激预防在机械通风患者的急性心肌梗塞
Soumya Banna1, Christopher Schenck1, Andi Shahu2
1Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
JACC. Advances
|June 28, 2024
概括
对于急性心肌梗塞 (AMI) 需要机械呼吸的患者来说,与质子抑制剂 (PPI) 相比,组胺类型2受体抑制剂 (H2Bs) 并没有显著降低死亡率. H2Bs与更少的呼吸器日和更少的肺炎有关.
科学领域:
- 关键护理医学 关键护理医学
- 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:
- 质子抑制剂 (PPI) 和组胺类型2受体抑制剂 (H2Bs) 是机械通风患者应激预防的标准.
- 以前的研究表明,PPI可能会增加死亡率,但往往排除心血管患者.
- 接受侵入性机械呼吸 (IMV) 的急性心肌梗塞 (AMI) 患者代表了预防分析的独特人群.
研究的目的:
- 为了比较PPI和H2B之间的住院死亡率和其他结果,以预防压力.
- 为了特别研究 AMI 需要 IMV 的患者的这种比较.
- 评估PPI与H2B使用与这一队列中的死亡率之间的关系.
主要方法:
- 使用Vizient临床数据库 (2015年10月 - 2019年12月) 进行的回顾性队列研究.
- 包括初级AMI诊断需要IMV的成年患者 (≥18岁).
- 多变量后勤回归分析了预防类型和住院死亡率之间的关联.
主要成果:
- 分析了11,252名患者,66.7%接受了PPI,33.3%接受了H2Bs.
- 未经调整的分析显示,H2Bs的死亡率较低 (41.5%与43.5%,P=0.047).
- 多变量调整显示没有显著的死亡率差异 (OR 0.97;95% CI:0.89-1.06,P=0.49). H2B的使用与更少的通风器日,更少的VAP和更低的成本相关.
结论:
- 在需要IMV的AMI患者中,H2B和PPI之间没有显著的死亡率差异,用于压力的预防.
- 使用H2B与改善的二次结果有关,如减少呼吸机日和呼吸机相关的肺炎.
- 研究结果表明,在这种高风险心血管患者群体中,应仔细考虑预防选择.
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