Beta-blockers in isolated blunt head injury
Beta-blockers in isolated blunt head injury
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DOI：
10.1016/j.jamcollsurg.2007.10.005
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发表时间：
2008-03-01
影响因子：
5.2
通讯作者：
Demetriades, Demetrios
中科院分区：
文献类型：
--
作者：
Inaba, Kenji;Teixeira, Pedro Gr;Demetriades, Demetrios
背景：本研究的目的是评估β受体阻滞剂对急性创伤性脑损伤患者的作用。我们的假设是，β-受体阻滞剂暴露与生存率的提高有关。 研究设计：使用创伤登记处和学术一级创伤中心的外科 ICU 数据库来识别 1998 年 7 月至 2005 年 12 月期间所有遭受钝性头部损伤且需要入住 ICU 的患者。遭受严重相关损伤的患者（除头部以外的任何身体区域的简要损伤评分 >= 4）被排除在外。提取了患者人口统计数据、损伤概况、损伤严重程度评分和 β 受体阻滞剂暴露情况。评估的主要结局指标是院内死亡率。 结果：在 90 个月的研究期间，1, 156 名单纯性头部损伤患者入住 ICU。其中，203 人 (18%) 接受了 β 受体阻滞剂治疗，953 人 (82%) 没有接受治疗。接受β受体阻滞剂治疗的患者年龄较大（50 +/- 21岁对比38 +/- 20岁，p < 0.001），更频繁地发生严重（缩写损伤评分4）头部损伤（54%对比43%，p < 0.01），格拉斯哥昏迷量表= 4），服用β受体阻滞剂的患者死亡率为28%，而未接受β受体阻滞剂治疗的患者死亡率为60% （比值比：0.3；96% CI，0.1 至 0.6；p=0.001）。结论：β 受体阻滞剂对创伤性脑损伤患者的生存率改善独立相关。患有严重头部损伤的老年患者使用β-阻断剂可最大程度地降低死亡率。
BACKGROUND: The purpose of this study was to evaluate the effect of beta-blockers on patients sustaining acute traumatic brain injury. Our hypothesis was that beta-blocker exposure is associated with improved survival.STUDY DESIGN: The trauma registry and the surgical ICU databases of an academic Level I trauma center were used to identify all patients sustaining blunt head injury requiring ICU admission from July 1998 to December 2005. Patients sustaining major associated injuries (Abbreviated Injury Score >= 4 in any body region other than the head) were excluded. Patient demographics, injury profile, Injury Severity Score, and beta-blocker exposure were abstracted. The primary outcomes measure evaluated was in-hospital mortality.RESULTS: During the 90-month study period, 1, 156 patients with isolated head injury were admitted to the ICU. Of these, 203 (18%) received beta-blockers and 953 (82%) did not. Patients receiving beta-blockers were older (50 +/- 21 years versus 38 +/- 20 years, p < 0.001), had more frequent severe (Abbreviated Injury Score 4) head injury (54% versus 43%, p < 0.01), Glasgow Coma Scale = 4) had a mortality of 28% on beta-blockers as compared with 60% when they did not receive them (odds ratio: 0.3; 96% CI, 0.1 to 0.6; p=0.001).CONCLUSIONS: Beta-blockade in patients with traumatic brain injury was independently associated with improved survival. Older patients with severe head injuries demonstrated the largest reduction in mortality with beta-blockade.