脑出血患者静脉注射硝普钠和尼卡地平治疗相关结局的多中心比较。
A multicenter comparison of outcomes associated with intravenous nitroprusside and nicardipine treatment among patients with intracerebral hemorrhage.
作者信息
Suri M Fareed K, Vazquez Gabriela, Ezzeddine Mustapha A, Qureshi Adnan I
机构信息
Zeenat Qureshi Stroke Research Center, Minnesota Stroke Initiative, Department of Neurology, University of Minnesota, 12-100 PWB, 516 Delaware St. SE, Minneapolis, MN 55455, USA.
出版信息
Neurocrit Care. 2009;11(1):50-5. doi: 10.1007/s12028-009-9192-1. Epub 2009 Feb 18.
INTRODUCTION
No clinical data exist to compare outcomes between patients with intracerebral hemorrhage (ICH) treated with different intravenous antihypertensive agents. This study was performed to compare outcomes among patients with ICH who were treated with intravenous infusion of different antihypertensive medications during the first 24 hours after admission.
METHODS
We analyzed one-year data (2005-2006) from the Premier database which is a nationally representative hospital discharge database containing data pertaining to admissions in the United States. We compared discharge outcomes, length of stay, and cost of hospitalization between groups of patients who were treated using either intravenous nicardipine or nitroprusside infusion. Chi-square and ANOVA were used for univariate analysis. Logistic and linear regression analyses were performed to adjust for baseline risk of mortality between the two groups.
RESULTS
A total of 12,767 admissions with primary diagnosis of ICH were identified. Nicardipine was administered in 926 patients (7.3%) and nitroprusside was administered in 530 (4.3%) patients. There was no difference in baseline disease severity or risk of mortality among patients who were administered nicardipine or nitroprusside. After adjustment for baseline risk of mortality, the risk of in-hospital mortality (odds ratio [OR] 1.7, 95% confidence interval [95% CI] 1.3-2.2) was higher among patients treated with nitroprusside compared with nicardipine. The risk of in-hospital mortality was also higher after adjustment for baseline risk of mortality and hospital characteristics in patients treated with nitroprusside (OR 1.6, 95% CI 1.2-2.1). After exclusion of patients who died during hospitalization, there was no difference in length of stay and total hospital cost in the multivariate analysis.
CONCLUSION
Use of nicardipine compared with nitroprusside infusion during the first 24 h after ICH may be associated with reduced risk of in-hospital mortality without any increase in the hospitalization cost or length of stay.
引言
目前尚无临床数据可用于比较接受不同静脉降压药物治疗的脑出血（ICH）患者的预后。本研究旨在比较脑出血患者在入院后24小时内接受不同静脉降压药物输注治疗后的预后情况。
方法
我们分析了Premier数据库中2005年至2006年的一年数据，该数据库是一个具有全国代表性的医院出院数据库，包含美国住院患者的数据。我们比较了接受静脉尼卡地平或硝普钠输注治疗的患者组之间的出院结局、住院时间和住院费用。采用卡方检验和方差分析进行单因素分析。进行逻辑回归和线性回归分析以调整两组之间的基线死亡风险。
结果
共确定了12767例以脑出血为主要诊断的入院病例。926例患者（7.3%）接受了尼卡地平治疗，530例患者（4.3%）接受了硝普钠治疗。接受尼卡地平或硝普钠治疗的患者在基线疾病严重程度或死亡风险方面没有差异。在调整基线死亡风险后，与尼卡地平治疗的患者相比，接受硝普钠治疗的患者院内死亡风险更高（优势比[OR]1.7，95%置信区间[95%CI]1.3 - 2.2）。在调整基线死亡风险和医院特征后，接受硝普钠治疗的患者院内死亡风险也更高（OR 1.6，95%CI 1.2 - 2.1）。排除住院期间死亡的患者后，多因素分析中住院时间和总住院费用没有差异。
结论
脑出血后24小时内使用尼卡地平与硝普钠输注相比，可能降低院内死亡风险，且不增加住院费用或住院时间。
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