在重症监护病房中，β受体阻滞剂用于慢性阻塞性肺疾病合并呼吸衰竭患者的安全性。
The safety of beta-blocker use in chronic obstructive pulmonary disease patients with respiratory failure in the intensive care unit.
作者信息
Kargin Feyza, Takir Huriye Berk, Salturk Cuneyt, Goksenoglu Nezihe Ciftaslan, Karabay Can Yucel, Mocin Ozlem Yazicioglu, Adiguzel Nalan, Gungor Gokay, Balci Merih Kalamanoglu, Yalcinsoy Murat, Kargin Ramazan, Karakurt Zuhal
机构信息
Respiratory and Intensive Care Unit, Sureyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, Soyak Yenişehir Manolya Evleri, 34770 Umraniye, Istanbul, Turkey.
出版信息
Multidiscip Respir Med. 2014 Feb 4;9(1):8. doi: 10.1186/2049-6958-9-8.
BACKGROUND
The safety of beta-blockers as a heart rate-limiting drug (HRLD) in patients with acute respiratory failure (ARF) due to chronic obstructive lung disease (COPD) has not been properly assessed in the intensive care unit (ICU) setting. This study aims to compare the use of beta-blocker drugs relative to non-beta-blocker ones in COPD patients with ARF due to heart rate-limiting with respect to length of ICU stay and mortality.
METHODS
We performed a retrospective (January 2011-December 2012) case-control study in a level III ICU in a teaching hospital. It was carried out in a closed ICU by the same intensivists. All COPD patients with ARF who were treated with beta-blockers (case group) and non-beta-blocker HRLDs (control group) were included. Their demographics, reason for HRLD, cause of ARF, comorbidities, ICU data including acute physiology and chronic health evaluation (APACHE II) score, type of ventilation, heart rate, and lengths of ICU and hospital stays were collected. The mortality rates in the ICU, the hospital, and over 30 days were also recorded.
RESULTS
We enrolled 188 patients (46 female, n = 74 and n = 114 for the case and control groups, respectively). Reasons for HRLD (case and control group, respectively) were atrial fibrillation (AF, 23% and 50%), and supraventricular tachycardia (SVT, 41.9% and 54.4%). Patients' characteristics, APACHE II score, heart rate, duration and type of ventilation, and median length of ICU-hospital stay were similar between the groups. The mortality outcomes in the ICU, hospital, and 30 days after discharge in the case and control groups were 17.6% versus 15.8% (p > 0.75); 18.9% versus 19.3% (p > 0.95) and 20% versus 11% (p > 0.47), respectively.
CONCLUSIONS
Our results suggest that beta-blocker use for heart rate control in COPD patients with ARF is associated with similar ICU stay length and mortality compared with COPD patients treated with other HRLDs.
背景
在重症监护病房（ICU）环境中，β受体阻滞剂作为慢性阻塞性肺疾病（COPD）所致急性呼吸衰竭（ARF）患者心率限制药物（HRLD）的安全性尚未得到充分评估。本研究旨在比较使用β受体阻滞剂药物与非β受体阻滞剂药物对因心率限制导致ARF的COPD患者在ICU住院时间和死亡率方面的影响。
方法
我们在一家教学医院的三级ICU进行了一项回顾性（2011年1月至2012年12月）病例对照研究。由同一名重症监护医生在封闭的ICU中进行。纳入所有接受β受体阻滞剂治疗的ARF的COPD患者（病例组）和接受非β受体阻滞剂HRLD治疗的患者（对照组）。收集他们的人口统计学资料、HRLD的原因、ARF的病因、合并症、ICU数据，包括急性生理与慢性健康状况评分系统（APACHE II）评分、通气类型、心率以及ICU和住院时间。还记录了ICU、医院及30天内的死亡率。
结果
我们纳入了188例患者（46例女性，病例组和对照组分别为n = 74例和n = 114例）。HRLD的原因（病例组和对照组）分别为心房颤动（AF，23%和50%）和室上性心动过速（SVT，41.9%和54.4%）。两组患者的特征、APACHE II评分、心率、通气持续时间和类型以及ICU - 住院中位时间相似。病例组和对照组在ICU、医院及出院后30天的死亡率分别为17.6%对15.8%（p > 0.75）；18.9%对19.3%（p > 0.95）和20%对11%（p > 0.47）。
结论
我们的结果表明，与使用其他HRLD治疗的COPD患者相比，使用β受体阻滞剂控制ARF的COPD患者的心率，其ICU住院时间和死亡率相似。
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