Etomidate Use and Postoperative Outcomes among Cardiac Surgery Patients
Etomidate Use and Postoperative Outcomes among Cardiac Surgery Patients
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DOI：
10.1097/aln.0000000000000087
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发表时间：
2014-03-01
期刊：
影响因子：
8.8
通讯作者：
Pretorius, Mias
中科院分区：
文献类型：
--
作者：
Wagner, Chad E.;Bick, Julian S.;Pretorius, Mias
背景：虽然单剂量依托咪酯可引起相对肾上腺功能不全，但依托咪酯暴露对术后预后的影响尚不清楚。本研究的目的是检查单次诱导剂量依托咪酯与心脏手术后临床重要的术后结局之间的关系。方法：回顾性分析2007年1月至2009年12月心脏手术患者麻醉诱导时依托咪酯暴露与术后结局的关系，采用多因素logistic回归分析和Cox比例风险回归分析。术后结局是严重低血压、机械通气时间、住院时间和住院死亡率。结果：3127例患者中有62%接受依托咪酯治疗。依托咪酯患者术前充血性心力衰竭发生率较高（23.0%比18.3%,P = 0.002），心源性休克发生率较低（1.3比4.0%,P < 0.001）。与使用依托咪酯相关的严重低血压和院内死亡率的校正优势比分别为0.80 （95% CI, 0.58-1.09）和0.75 (95% CI, 0.45-1.24)，机械通气移除时间和出院时间的校正风险比分别为1.10 （95% CI, 1.00-1.21）和1.07 （95% CI, 0.97-1.18）。倾向评分分析没有改变依托咪酯使用与术后预后之间的关系。结论：在本研究中，没有证据表明依托咪酯暴露与严重低血压、更长的机械通气时间、更长的住院时间或院内死亡率相关。依托咪酯仍应作为心脏手术患者诱导麻醉的一种选择。
Background: Although a single dose of etomidate can cause relative adrenal insufficiency, the impact of etomidate exposure on postoperative outcomes is unknown. The objective of this study was to examine the association between a single induction dose of etomidate and clinically important postoperative outcomes after cardiac surgery.Methods: The authors retrospectively examined the association between etomidate exposure during induction of anesthesia and postoperative outcomes in patients undergoing cardiac surgery from January 2007 to December 2009 by using multivariate logistic regression analyses and Cox proportional hazards regression analyses. Postoperative outcomes of interest were severe hypotension, mechanical ventilation hours, hospital length of stay, and in-hospital mortality.Results: Sixty-two percent of 3,127 patients received etomidate. Etomidate recipients had a higher incidence of preoperative congestive heart failure (23.0 vs. 18.3%; P = 0.002) and a lower incidence of preoperative cardiogenic shock (1.3 vs. 4.0%; P < 0.001). The adjusted odds ratio for severe hypotension and in-hospital mortality associated with receiving etomidate was 0.80 (95% CI, 0.58-1.09) and 0.75 (95% CI, 0.45-1.24), respectively, and the adjusted hazard ratio for time to mechanical ventilation removal and time to hospital discharge was 1.10 (95% CI, 1.00-1.21) and 1.07 (95% CI, 0.97-1.18), respectively. Propensity score analysis did not change the association between etomidate use and postoperative outcomes.Conclusions: In this study, there was no evidence to suggest that etomidate exposure was associated with severe hypotension, longer mechanical ventilation hours, longer length of hospital stay, or in-hospital mortality. Etomidate should remain an option for induction of anesthesia in cardiac surgery patients.