Adverse events after prehospital nitroglycerin administration in a nationwide registry analysis.
Adverse events after prehospital nitroglycerin administration in a nationwide registry analysis.
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DOI：
10.1016/j.ajem.2021.08.006
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发表时间：
2021-12
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硝酸甘油（NTG）是一种血管扩张剂，用于院前胸痛患者。潜在的不良反应包括低血压、心动过缓或心动过速以及精神状态改变。然而，尚不清楚哪些因素（如果有的话）与患者在接受NTG后发生不良事件相关。本研究的目的是确定与院前NTG给药后不良事件相关的人口统计学和临床因素。ESO Data Collaborative（Austin，TX）包含来自1322个EMS机构的记录，查询了911例通过EMS给予≥18岁患者NTG的病例。不良事件结局定义为NTG给药后新的收缩压（SBP）< 90，心率（HR）< 50 or >120，平均动脉压（MAP）< 65或精神状态变化。采用描述性统计和logistic回归模型对年龄、性别、人种、种族、静脉（IV）通路和初始生命体征进行调整，以评估不良事件相关因素。在80，760次遭遇中，平均年龄为61岁（IQR 50-72），其中52%为男性，71%为白色人种，7%为西班牙裔。不良事件发生在7%的遭遇。发现黑人患者中不良事件较不常见（OR = 0.74，95% CI：0.69-0.80）。NTG给药前获得IV通路与较少的不良事件相关（OR = 0.92，95%CI：0.85-0.99）。年龄（OR = 1.02，95%CI：1.01-1.02）和HR（OR = 1.03，95%CI：1.02-1.03）的增加与不良事件的几率增加相关，而SBP（OR = 0.99，95%CI：0.98-0.99）呈负相关。院前NTG给药后的不良事件很少发生，尤其是在SBP > 110和HR < 100的患者中，在现有IV通路的患者中更不常见。未发现人口统计学具有临床意义。
Nitroglycerin (NTG) is a vasodilator used in the prehospital setting with chest pain patients. Potential adverse effects include hypotension, bradycardia or tachycardia, and mental status change. However, it is unclear which factors, if any, are associated with patients having an adverse event after receiving NTG. The objective of this study was to determine demographic and clinical factors associated with adverse events after prehospital NTG administration. The ESO Data Collaborative (Austin, TX), containing records from 1322 EMS agencies, was queried for 911 encounters where NTG was administered to patients ≥18 years old by EMS. Adverse event outcomes were defined as a new systolic blood pressure (SBP) < 90, heart rate (HR) < 50 or > 120, mean arterial pressure (MAP) < 65, or change in mental status following NTG administration. Descriptive statistics and logistic regression models adjusting for age, sex, race, ethnicity, intravenous (IV) access, and initial vital signs were used to assess for adverse event-related factors. Among 80,760 encounters, the mean age was 61 (IQR 50–72), with 52% males, 71% white race, and 7% Hispanic ethnicity. Adverse events occurred in 7% of encounters. Adverse events were found to be less common among Black patients (OR = 0.74, 95% CI:0.69–0.80). IV access obtained prior to NTG administration was associated with fewer adverse events (OR = 0.92, 95%CI:0.85–0.99). Increasing age (OR = 1.02, 95%CI:1.01–1.02) and HR (OR = 1.03, 95%CI:1.02–1.03) were associated with increased odds of adverse events while SBP (OR = 0.99, 95%CI:0.98–0.99) was inversely associated. Adverse events following prehospital NTG administration were rare, especially in patients with an SBP > 110 and a HR < 100, and less frequent in those with existing IV access. Demographics were not found to be clinically significant.
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影响因子：
3.1
作者：
Boyle, Malcolm J.
通讯作者：
Boyle, Malcolm J.
影响因子：
6.2
作者：
WUERZ, R;SWOPE, G;ROTH, GS
通讯作者：
ROTH, GS
影响因子：
4.8
作者：
ABRAMS, J
通讯作者：
ABRAMS, J
影响因子：
2.8
作者：
FERGUSON, JJ;DIVER, DJ;PASTERNAK, RC
通讯作者：
PASTERNAK, RC
影响因子：
2.4
作者：
Bosson, Nichole;Isakson, Benjamin;Niemann, James T.
通讯作者：
Niemann, James T.