院前应用胺碘酮可能会增加高危患者急性呼吸窘迫综合征的发生率。
Prehospital amiodarone may increase the incidence of acute respiratory distress syndrome among patients at risk.
机构信息
Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Jacksonville, FL, USA.
出版信息
J Crit Care. 2012 Oct;27(5):447-53. doi: 10.1016/j.jcrc.2011.10.009. Epub 2012 Jan 4.
PURPOSE
Amiodarone has been implicated as a risk factor for acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) when used in the hospital. This study aims to estimate whether prehospital amiodarone also increases the risk of ALI/ARDS.
MATERIALS
Adult patients admitted to 22 centers with at least 1 risk factor for developing ALI were recruited. In a secondary analysis of this cohort, the prehospital use of amiodarone was documented on admission, and the patients followed for the primary outcome of ALI and secondary outcomes of ARDS, the need for invasive ventilation, and mortality. Dose/duration of amiodarone therapy was not available. Propensity matching was performed to account for imbalances in being assigned to amiodarone. The adjusted risk for ALI/ARDS was then estimated from a conditional logistic regression model of this propensity-matched set.
RESULTS
Forty of 5584 patients were on amiodarone at the time of hospitalization; of those, 6 developed ALI, with 5 progressing to ARDS. In comparison, 371 patients not on amiodarone developed ALI, with 224 having ARDS. After propensity score matching, the prehospital use of amiodarone was not statistically associated with an increased risk for all ALI (odds ratio [OR], 1.8; 95% confidence interval [CI], 0.7-5.0; P = .25), invasive ventilation (OR, 1.9; 95% CI, 1.0-3.6; P = .059), or in-hospital mortality (OR, 1.2; 95% CI, 0.5-2.9; P = .75); but its use appeared to significantly increase the risk for ARDS (OR 3.8; 95% CI, 1.1-13.1; P = .036).
CONCLUSIONS
Prehospital use of amiodarone may independently increase the risk for ARDS in patients who have at least 1 predisposing condition for ALI.
目的
当在医院使用时，胺碘酮已被牵连为急性肺损伤（ALI）和急性呼吸窘迫综合征（ARDS）的危险因素。本研究旨在评估院前使用胺碘酮是否也会增加 ALI/ARDS 的风险。
材料
招募了至少有 1 种发生 ALI 风险因素的 22 个中心的成年患者。在该队列的二次分析中，在入院时记录了院前使用胺碘酮的情况，并对 ALI 的主要结局和 ARDS、有创通气的需要以及死亡率的次要结局对患者进行随访。胺碘酮治疗的剂量/持续时间不可用。为了弥补被分配到胺碘酮的不平衡，进行了倾向评分匹配。然后，从这个倾向匹配组的条件逻辑回归模型中估计 ALI/ARDS 的调整风险。
结果
在 5584 名患者中，有 40 名患者在住院时使用了胺碘酮；其中 6 名患者发生 ALI，其中 5 名患者进展为 ARDS。相比之下，371 名未使用胺碘酮的患者发生了 ALI，其中 224 名患者患有 ARDS。在进行倾向评分匹配后，院前使用胺碘酮与所有 ALI（比值比 [OR]，1.8；95%置信区间 [CI]，0.7-5.0；P =.25）、有创通气（OR，1.9；95% CI，1.0-3.6；P =.059）或住院死亡率（OR，1.2；95% CI，0.5-2.9；P =.75）的增加均无统计学关联；但它的使用似乎显著增加了 ARDS 的风险（OR 3.8；95% CI，1.1-13.1；P =.036）。
结论
在至少有一种 ALI 诱发因素的患者中，院前使用胺碘酮可能会独立增加 ARDS 的风险。
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