Department of Critical Care Services, Neuroscience Institute, Maine Medical Center, Portland, ME 04102, USA.
Neurocrit Care. 2011 Feb;14(1):77-83. doi: 10.1007/s12028-010-9456-9.
We evaluated the safety of nicotine replacement therapy (NRT) in active smokers with acute (aneurysmal) subarachnoid hemorrhage (SAH).
A retrospective observational cohort study was conducted in a prospectively collected database including all SAH patients admitted to an 18-bed neuro-ICU between January 1, 2001 and October 1, 2007. Univariate and multivariable models were constructed, employing stepwise logistic regression. The primary endpoint was 3-month mortality. Delayed cerebral ischemia (DCI) due to vasospasm, angiographic and TCD evidence of vasospasm, and delirium were secondary endpoints.
Active cigarette smokers admitted with SAH included 128 that received NRT and 106 that did not. Patients were well-matched for age, admission Hunt-Hess Grade, radiographic findings, and APACHE II scores, but those who received NRT were more likely to be heavy smokers (>10 cigarettes daily), diabetic, heavy alcohol users, and to have cerebral edema on admission. NRT was associated in multivariate analysis with a lower risk of death at 3 months (OR 0.12, 95% CI 0.04-0.37, P < 0.001). There were no differences in the frequency of DCI and most other medical complications, but delirium (19 vs. 9%, P = 0.006) and seizures (9 vs. 2%, P = 0.024) were more common in patients who received NRT.
Despite vasoactive properties, administration of NRT among active smokers with acute SAH appeared to be safe, with similar rates of vasospasm and DCI, and a slightly higher rate of seizures. The association of NRT with lower mortality could be due to chance, to uncontrolled factors, or to a neuroprotective effect of nicotine in active smokers hospitalized with SAH, and should be tested prospectively.
我们评估了尼古丁替代疗法（NRT）在急性（动脉瘤性）蛛网膜下腔出血（SAH）活动吸烟者中的安全性。
对 2001 年 1 月 1 日至 2007 年 10 月 1 日期间在 18 张床位的神经重症监护病房收治的所有 SAH 患者前瞻性收集的数据库中进行了回顾性观察队列研究。采用逐步逻辑回归构建单变量和多变量模型。主要终点为 3 个月死亡率。次要终点为迟发性脑缺血（DCI）因血管痉挛、血管造影和 TCD 血管痉挛证据以及谵妄。
SAH 入院的活跃吸烟者中，有 128 人接受了 NRT，106 人未接受。患者在年龄、入院时的 Hunt-Hess 分级、影像学发现和急性生理与慢性健康评分（APACHE II）评分方面匹配良好，但接受 NRT 的患者更有可能是重度吸烟者（>10 支/日）、糖尿病、重度饮酒者，且入院时脑水肿更常见。多变量分析显示，NRT 与 3 个月时死亡风险降低相关（OR 0.12，95%CI 0.04-0.37，P <0.001）。DCI 发生率和大多数其他医疗并发症无差异，但接受 NRT 的患者谵妄（19% vs. 9%，P=0.006）和癫痫发作（9% vs. 2%，P=0.024）更为常见。
尽管 NRT 具有血管活性作用，但在急性 SAH 的活动吸烟者中使用似乎是安全的，血管痉挛和 DCI 发生率相似，癫痫发作率略高。NRT 与死亡率降低相关可能是偶然的，可能是由于未控制的因素，也可能是尼古丁对住院治疗的 SAH 活动吸烟者具有神经保护作用，应进行前瞻性测试。
