Mrozek S, Constantin J-M, Futier E, Zenut M, Ghardes G, Cayot-Constantin S, Bonnard M, Ait-Bensaid N, Eschalier A, Bazin J-E
Service de réanimation adultes, pôle anesthésie-réanimation, Hôtel-Dieu, centre hospitalier universitaire de Clermont-Ferrand, boulevard Léon-Malfreyt, 63058 Clermont-Ferrand cedex 1, France.
Ann Fr Anesth Reanim. 2009 May;28(5):448-53. doi: 10.1016/j.annfar.2009.01.018. Epub 2009 Mar 21.
The aim of this study was to evaluate the incidence of paracetamol-induced hypotension in intensive care unit (ICU). The secondary end-point was the description of pathophysiologic phenomenon during this hypotension and risk factors.
An observational study in three ICU of a French teaching hospital.
All consecutives patients whom benefit from intravenous paracetamol administration were included in the study. When a 20% droop in arterial blood pressure occurred, plasma samples were obtained and tryptases were measured at 6 and 48 hours. Clinical, biological characteristics and paracetamol administration duration were prospectively monitored.
During a 2-months period, 127 ICU patients were included in the study with 1507 paracetamol administration. Twenty droops in arterial blood pressure were recorded in ICU. The incidence rate was 1.33%. Administration duration was 32+/-9 min. No respiratory nor cutaneous manifestations occurred during hypotensions. A specific treatment was administrated in half of the patients. Hypotension incidence was higher (3.9%) in patients with brain injury. Eighty percent of patients with hypotension have a severe sepsis or a septic shock.
In this cohort of ICU patients, hypotension incidence was higher than reported in drug legal mentions. Immunoallergic phenomenon was excluded. Brain injury and sepsis seems to be risk factors.
本研究旨在评估重症监护病房（ICU）中对乙酰氨基酚诱发低血压的发生率。次要终点是描述该低血压期间的病理生理现象及危险因素。
在一家法国教学医院的三个ICU进行的一项观察性研究。
所有连续接受静脉注射对乙酰氨基酚治疗的患者均纳入本研究。当动脉血压下降20%时，采集血浆样本并在6小时和48小时测量类胰蛋白酶。对临床、生物学特征及对乙酰氨基酚给药持续时间进行前瞻性监测。
在为期2个月的期间内，127例ICU患者纳入研究，共进行了1507次对乙酰氨基酚给药。在ICU记录到20次动脉血压下降。发生率为1.33%。给药持续时间为32±9分钟。低血压期间未出现呼吸或皮肤表现。一半患者接受了特异性治疗。脑损伤患者的低血压发生率较高（3.9%）。80%的低血压患者患有严重脓毒症或脓毒性休克。
在这组ICU患者中，低血压发生率高于药品法定说明中所报告的。免疫过敏现象被排除。脑损伤和脓毒症似乎是危险因素。
