背景:尽管指南推荐神经肌肉阻滞剂(NMBAs)作为ARDS患者的治疗方法,NMBA的功效仍存在争议。我们的研究旨在调查顺式阿曲库铵输注与中度和重度ARDS危重患者的中期和长期预后之间的关系。
方法:我们执行了单中心,基于重症监护医学信息集市III(MIMIC-III)数据库的485例危重成人ARDS患者的回顾性研究。倾向评分匹配(PSM)用于将接受NMBA管理的患者与未接受NMBA的患者进行匹配。Cox比例风险模型,Kaplan-Meier方法,和亚组分析用于评估NMBA治疗与28天死亡率之间的关系。
结果:共对485例中度和重度ARDS患者进行了回顾,86对PSM后患者进行了匹配。NMBAs与降低28天死亡率无关(风险比(HR)1.44;95%CI:0.85~2.46;p=0.20),90天死亡率(HR=1.49;95%CI:0.92~2.41;p=0.10),1年死亡率(HR=1.34;95%CI:0.86~2.09;p=0.20),或住院死亡率(HR=1.34;95%CI:0.81~2.24;p=0.30)。然而,NMBAs与延长的通气时间和ICU住院时间有关。
结论:NMBA与中期和长期生存率的改善无关,可能导致一些不良的临床结局。
BACKGROUND: Although neuromuscular blocker agents (
NMBAs) are recommended by guidelines as a treatment for ARDS patients, the efficacy of
NMBAs is still controversial. Our study aimed to investigate the association between cisatracurium infusion and the medium- and long-term outcomes of critically ill patients with moderate and severe ARDS.
METHODS: We performed a single-center, retrospective study of 485 critically ill adult patients with ARDS based on the Medical Information Mart for Intensive Care III (MIMIC-III) database. Propensity score matching (PSM) was used to match patients receiving NMBA administration with those not receiving NMBAs. The Cox proportional hazards model, Kaplan-Meier method, and subgroup analysis were used to evaluate the relationship between NMBA therapy and 28-day mortality.
RESULTS: A total of 485 moderate and severe patients with ARDS were reviewed and 86 pairs of patients were matched after PSM.
NMBAs were not associated with reduced 28-day mortality (hazard ratio (HR) 1.44; 95% CI: 0.85~2.46; p = 0.20), 90-day mortality (HR = 1.49; 95% CI: 0.92~2.41; p = 0.10), 1-year mortality (HR = 1.34; 95% CI: 0.86~2.09; p = 0.20), or hospital mortality (HR = 1.34; 95% CI: 0.81~2.24; p = 0.30). However,
NMBAs were associated with a prolonged duration of ventilation and the length of ICU stay.
CONCLUSIONS: NMBAs were not associated with improved medium- and long-term survival and may result in some adverse clinical outcomes.