Medina-Concepción Agustín, del Cristo Acosta-Ramos María, Pérez-García Isabel, García-Díaz Abraham, Plasencia-Hernández Cristina, Díaz-Melián Auxiliadora, Jiménez-Sosa Alejandro
PACU-Reanimation Section, HUC, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain.
J Perianesth Nurs. 2011 Feb;26(1):25-34. doi: 10.1016/j.jopan.2010.11.002.
To determine whether treatment with moderate-high dose norepinephrine is a contributory cause increasing the risk of pressure ulcer development in critical postoperative, mechanically ventilated, hyperglycemic patients. A pilot clinical cohort study was conducted in a PACU in a tertiary hospital. A convenience sample of 16 hyperglycemic patients undergoing mechanical ventilation with at least 24 hours' stay in the PACU were divided into two groups of eight according to dosage of norepinephrine infusion at any moment during the days monitored. One group received ≥ 2.5 mg/hour, and the other received <2.5 mg/hour. The dose of norepinephrine administered by continuous venous infusion and the occurrence of stage II pressure ulcers were recorded. The proportion of patients with pressure ulcers in the group receiving moderate-high dose of norepinephrine was 50% compared with 0% in the low-dose group (P = .038). The odds ratio for daily average norepinephrine administered (mg/hour) was 2.21 (95% CI = 1.27 to +infinite); exact P = .0049. The odds ratio for daily average norepinephrine administered adjusting for weight (mg/kg/hour) was 3.05 (95% CI = 1.299 to +infinite); exact P = .0016. Moderate-high dose norepinephrine is a contributory cause that significantly increases the risk of pressure ulcer development in certain short-stay PACU patients.
为确定中高剂量去甲肾上腺素治疗是否是导致术后重症、机械通气、高血糖患者发生压疮风险增加的一个促成因素。在一家三级医院的麻醉后监护室(PACU)进行了一项前瞻性临床队列研究。选取16例在PACU接受机械通气且至少停留24小时的高血糖患者作为便利样本,根据监测期间任何时刻去甲肾上腺素输注剂量分为两组,每组8例。一组接受≥2.5毫克/小时的剂量,另一组接受<2.5毫克/小时的剂量。记录持续静脉输注去甲肾上腺素的剂量和II期压疮的发生情况。接受中高剂量去甲肾上腺素组的压疮患者比例为50%,而低剂量组为0%(P = 0.038)。每日平均给予去甲肾上腺素(毫克/小时)的比值比为2.21(95%可信区间 = 1.27至正无穷);确切P = 0.0049。调整体重后每日平均给予去甲肾上腺素(毫克/千克/小时) 的比值比为3.05(95%可信区间 = 1.299至正无穷);确切P = 0.0016。中高剂量去甲肾上腺素是导致某些短期停留PACU患者发生压疮风险显著增加的一个促成因素。