在成年烧伤患者中，使用β受体阻滞剂与改善预后相关。

Beta-blocker use is associated with improved outcomes in adult burn patients.

作者信息

Arbabi Saman, Ahrns Karla S, Wahl Wendy L, Hemmila Mark R, Wang Stewart C, Brandt Mary-Margaret, Taheri Paul A

机构信息

Department of Surgery, University of Michigan health System, Ann Arbor, Michigan 48109-0033, USA.

出版信息

J Trauma. 2004 Feb;56(2):265-9; discussion 269-71. doi: 10.1097/01.TA.0000109859.91202.C8.

DOI:10.1097/01.TA.0000109859.91202.C8

PMID:14960966

Abstract

BACKGROUND

There is no direct evidence that beta-blockers improve mortality in burn victims. Beta-blockers attenuate hypermetabolic states in burned children, and perioperative use in elective adult cases has beneficial effects, which suggests that beta-blockers may also improve burn outcomes. However, beta-blockers decrease cardiac output and may decrease oxygen delivery, and theoretically may increase mortality. What is the effect of beta-blockers on healing time and mortality in burn patients?

METHODS

This was a retrospective cohort study. We identified three cohorts of adult burn patients between 1996 and 2001: all who were on beta-blockers (BB) before their injury (PMH BB); all who were initiated on BB during their hospitalization for management of hypertension or tachyarrhythmia (HOSP BB); and control, who were never treated with beta-blockers. For each patient in the PMH BB and HOSP BB groups, two patients were placed in the control cohort by matching age and total body surface area burn. Premorbid conditions such as diabetes, hypertension, cardiac disease, renal insufficiency, and diuretic and calcium channel blocker use were analyzed. Multivariate regression models were used to identify independent modifiers.

RESULTS

There were 21 PMH BB, 22 HOSP BB, and 86 control patients. All PMH BB patients remained on their BB regimen in the hospital. HOSP BB patients were initiated on beta-blockers at a mean of 8.8 days postinjury. There were no differences in age (mean, 58 +/- 17 years), total body surface area burned (mean, 14 +/- 12%), or mechanism of injury among the cohorts. The mortality rate was 5% for the PMH BB cohort, 27% for the HOSP BB cohort, and 13% for controls. The mean healing times were 51 +/- 29 days for PMH BB patients, 79 +/- 54 days for HOSP BB patients, and 60 +/- 39 for controls. In multivariate analyses, PMH BB was associated with a significant decrease in fatal outcome and healing time (p < or = 0.05 compared with control).

CONCLUSION

Beta-blockers have the potential to improve adult burn outcomes. Postinjury treatment should be studied in a randomized, clinical trial.

摘要

背景

尚无直接证据表明β受体阻滞剂能改善烧伤患者的死亡率。β受体阻滞剂可减轻烧伤儿童的高代谢状态，在择期成人病例的围手术期使用有有益效果，这表明β受体阻滞剂可能也会改善烧伤结局。然而，β受体阻滞剂会降低心输出量并可能减少氧输送，理论上可能增加死亡率。β受体阻滞剂对烧伤患者的愈合时间和死亡率有何影响？

方法

这是一项回顾性队列研究。我们确定了1996年至2001年间三组成年烧伤患者：所有在受伤前服用β受体阻滞剂（PMH BB）的患者；所有在住院期间因高血压或快速性心律失常的治疗而开始服用β受体阻滞剂（HOSP BB）的患者；以及从未接受过β受体阻滞剂治疗的对照组。对于PMH BB组和HOSP BB组中的每一位患者，通过匹配年龄和烧伤总面积，将两名患者纳入对照组。分析了糖尿病、高血压、心脏病、肾功能不全等病前状况以及利尿剂和钙通道阻滞剂的使用情况。使用多变量回归模型来确定独立的影响因素。

结果

有21例PMH BB患者、22例HOSP BB患者和86例对照患者。所有PMH BB患者在住院期间继续服用其β受体阻滞剂治疗方案。HOSP BB患者在受伤后平均8.8天开始使用β受体阻滞剂。三组患者在年龄（平均58±17岁）、烧伤总面积（平均14±12%）或受伤机制方面无差异。PMH BB组的死亡率为5%，HOSP BB组为27%，对照组为13%。PMH BB患者的平均愈合时间为51±29天，HOSP BB患者为79±54天，对照组为60±39天。在多变量分析中，PMH BB与致命结局和愈合时间的显著降低相关（与对照组相比，p≤0.05）。