创伤性脑损伤与β受体阻滞剂：并非所有药物都一样。

Traumatic brain injury and β-blockers: not all drugs are created equal.

机构信息

From the University of Tennessee Health Science Center; and Department of Pharmacy, Regional Medical Center at Memphis, Memphis, Tennessee.

出版信息

J Trauma Acute Care Surg. 2014 Feb;76(2):504-9; discussion 509. doi: 10.1097/TA.0000000000000104.

DOI:10.1097/TA.0000000000000104

PMID:24458058

Abstract

BACKGROUND

Dysautonomia in traumatic brain injury patients may contribute to secondary injury. We hypothesize that propranolol is the best β-blocker (BB) to block the excess catecholamines and improve mortality in this patient population.

METHODS

Patients with traumatic brain injury admitted during a 48-month period who received BB were compared with those who did not after excluding patients who received preinjury BB, deaths within 48 hours, and head Abbreviated Injury Scale (AIS) score of less than 3 or greater than 5. In addition, propranolol was also compared with all other BBs.

RESULTS

A total of 1,755 patients with traumatic brain injury were identified during the study period after exclusions. Patients who received BB (427) were older (49 years vs. 40 years; p < 0.0001), were more severely injured (Injury Severity Score [ISS], 30 vs. 24; p < 0.001), and had a more severe head injury (head AIS score, 4.2 vs. 4.0; p < 0.001). By univariate analysis, BB patients had a higher mortality (13% vs. 6%; p < 0.001); after adjusted analysis, no difference was identified (adjusted odds ratio, 0.850; 95% confidence interval, 0.536-1.348). Seventy-eight patients (18%) received propranolol during the study period. Propranolol patients were younger (30 years vs. 53 years; p < 0.001) but more severely injured (ISS, 33 vs. 29; p = 0.01; head AIS, 4.5 vs. 4.2; p < 0.001), with longer stay (44 days vs. 26 days, p < 0.001). Mortality was less in the propranolol group (3% vs. 15%, p = 0.002). Adjusted analysis confirmed the protective effect of propranolol (adjusted odds ratio, 0.199; 95% confidence interval, 0.043-0.920).

CONCLUSION

Propranolol is the best BB to limit secondary injury and decrease mortality in patients with traumatic brain injury.

LEVEL OF EVIDENCE

Therapeutic, study level III.

摘要

背景

创伤性脑损伤患者的自主神经功能障碍可能导致继发性损伤。我们假设普萘洛尔是阻断过量儿茶酚胺并改善此类患者死亡率的最佳β受体阻滞剂（β-Blocker，BB）。

方法

在排除接受术前 BB、伤后 48 小时内死亡以及头部损伤严重程度评分（Abbreviated Injury Scale，AIS）小于 3 分或大于 5 分的患者后，我们比较了在 48 个月期间入院并接受 BB 治疗的创伤性脑损伤患者与未接受 BB 治疗的患者。此外，我们还比较了普萘洛尔与其他所有 BB 的疗效。

结果

研究期间排除患者后，共确定了 1755 例创伤性脑损伤患者。接受 BB 治疗的患者（427 例）年龄更大（49 岁 vs. 40 岁；p < 0.0001），损伤更严重（损伤严重程度评分，30 分 vs. 24 分；p < 0.001），头部损伤更严重（头部 AIS 评分，4.2 分 vs. 4.0 分；p < 0.001）。单因素分析显示，BB 治疗患者的死亡率更高（13% vs. 6%；p < 0.001）；经校正分析后，两组间差异无统计学意义（校正比值比，0.850；95%置信区间，0.536-1.348）。研究期间，78 例（18%）患者接受了普萘洛尔治疗。普萘洛尔治疗患者更年轻（30 岁 vs. 53 岁；p < 0.001），但损伤更严重（ISS，33 分 vs. 29 分；p = 0.01；头部 AIS，4.5 分 vs. 4.2 分；p < 0.001），住院时间更长（44 天 vs. 26 天；p < 0.001）。普萘洛尔组死亡率更低（3% vs. 15%；p = 0.002）。校正分析证实了普萘洛尔的保护作用（校正比值比，0.199；95%置信区间，0.043-0.920）。