肠内沙丁胺醇可减少因颈髓损伤导致心动过缓的患者对变时性药物的需求。

Enteral albuterol decreases the need for chronotropic agents in patients with cervical spinal cord injury-induced bradycardia.

机构信息

From the Department of Surgery (C.H.E.), University of Nebraska Medical Center, Omaha, Nebraska; Division of Trauma & Emergency Surgery, Department of Surgery (C.R.S., C.S.C.), and Department of Pharmacy (J.J.D.), University of California, Davis Medical Center, Sacramento, California; and Department of Pharmacy (A.J.B.), Banner Good Samaritan Medical Center, Phoenix, Arizona.

出版信息

J Trauma Acute Care Surg. 2014 Feb;76(2):297-301; discussion 301-2. doi: 10.1097/TA.0000000000000118.

DOI:10.1097/TA.0000000000000118

PMID:24458037

Abstract

BACKGROUND

Cervical spinal cord injury (CSCI) is often complicated by autonomic instability and life-threatening bradycardia. β-adrenergic receptors offer a potential target for modulating cardiac vagal activity and heart rate. Enteral albuterol may mitigate symptomatic bradycardia in CSCI patients. The purpose of this study was to examine the effect of enteral albuterol on the frequency of symptomatic bradycardia and the need for rescue therapy in CSCI patients.

METHODS

The charts of CSCI patients admitted to a Level I trauma center from February 2008 through March 2012 were reviewed for demographics, episodes of symptomatic bradycardia (defined as heart rate < 60 beats per minute and systolic blood pressure < 90 mm Hg), use of enteral albuterol, hospital days requiring chronotropic use, and total atropine administered. In the albuterol group, patients received scheduled enteral albuterol after experiencing symptomatic bradycardia, with chronotropic agents used as needed for rescue treatment. In the no-albuterol group, only chronotropic agents were used as needed for rescue treatment. The albuterol and no-albuterol groups were compared using independent-samples Kruskal-Wallis test for total number of bradycardic episodes, hospital days requiring chronotropic use, and total atropine administered.

RESULTS

Eighteen patients with CSCI-induced bradycardia were identified. Eight patients received treatment with enteral albuterol, and 10 patients did not. The median age did not differ significantly between the two groups. However, the median Injury Severity Score (ISS) was higher in the albuterol group (median ISS, 36.5; interquartile range, 35-66.5 vs. median ISS 26; interquartile range, 27-37.25 in no-albuterol group). Patients receiving albuterol experienced 1.8 symptomatic bradycardic episodes versus 4.3 episodes in those patients not receiving albuterol (p = 0.08). Hospital days on chronotropic agents were significantly less in the albuterol group (1.8 vs. 8.6, p = 0.01). One patient, in the no-albuterol group, required pacemaker placement.

CONCLUSION

Enteral albuterol may reduce the frequency of symptomatic bradycardia in patients with CSCI, resulting in less rescue therapy using chronotropic agents.

LEVEL OF EVIDENCE

Therapeutic study, level IV.

摘要

背景

颈椎脊髓损伤（CSCI）常伴有自主神经不稳定和危及生命的心动过缓。β-肾上腺素能受体为调节心脏迷走神经活性和心率提供了一个潜在的靶点。肠内沙丁胺醇可能减轻 CSCI 患者的症状性心动过缓。本研究旨在探讨肠内沙丁胺醇对 CSCI 患者症状性心动过缓发作频率和需要抢救治疗的影响。

方法

回顾 2008 年 2 月至 2012 年 3 月期间在一级创伤中心收治的 CSCI 患者的病历，记录人口统计学资料、症状性心动过缓发作（定义为心率<60 次/分钟和收缩压<90mmHg）、肠内沙丁胺醇使用、需要使用变时性药物的住院天数和总阿托品用量。在沙丁胺醇组，患者在出现症状性心动过缓后接受计划的肠内沙丁胺醇治疗，需要时使用变时性药物进行抢救治疗。在无沙丁胺醇组，仅在需要时使用变时性药物进行抢救治疗。使用独立样本 Kruskal-Wallis 检验比较沙丁胺醇组和无沙丁胺醇组的总心动过缓发作次数、需要使用变时性药物的住院天数和总阿托品用量。

结果

确定了 18 例 CSCI 引起的心动过缓患者。8 例患者接受肠内沙丁胺醇治疗，10 例患者未接受治疗。两组患者的中位年龄无显著差异。然而，沙丁胺醇组的中位损伤严重程度评分（ISS）较高（中位 ISS，36.5；四分位间距，35-66.5 与无沙丁胺醇组的中位 ISS 26；四分位间距，27-37.25）。接受沙丁胺醇治疗的患者发生 1.8 次症状性心动过缓发作，而未接受沙丁胺醇治疗的患者发生 4.3 次（p=0.08）。沙丁胺醇组使用变时性药物的住院天数明显减少（1.8 天与 8.6 天，p=0.01）。无沙丁胺醇组 1 例患者需要放置起搏器。