From the Division of Acute Care Surgery (S.M., G.W., O.L.), Department of Surgery, Orebro University Hospital, Orebo; and Division of Acute Care Surgery and Trauma (P.T., L.R.), Department of Surgery, Karolinska University Hospital, Stockholm, Sweden.
J Trauma Acute Care Surg. 2014 Mar;76(3):804-8. doi: 10.1097/TA.0000000000000139.
The purpose of this study was to investigate the effect of preinjury β-blockade in patients experiencing isolated severe traumatic brain injury (TBI). We hypothesized that β-blockade before TBI is associated with improved survival.
The trauma registry of an urban academic trauma center was queried to identify patients with an isolated severe TBI between January 2007 and December 2011. Isolated severe TBI was defined as an intracranial injury with an Abbreviated Injury Scale (AIS) score of 3 or greater excluding all extracranial injuries AIS score of 3 or greater. Patient demographics, clinical characteristics on admission, injury profile, Injury Severity Score (ISS), AIS score, in-hospital morbidity, and β-blocker exposure were abstracted for analysis. The primary outcome evaluated was in-hospital mortality stratified by preinjury β-blockade exposure.
Overall, a total of 662 patients met the study criteria. Of these, 25% (n = 159) were exposed to β-blockade before their traumatic insult. When comparing the demographics and injury characteristics between the groups, the sole difference was age, with the β-blocked group being older (69 [12] years vs. 63 [13] years, p < 0.001). β-blocked patients had a higher rate of infectious complications (30% vs. 19%, p = 0.04), with no difference in cardiac or pulmonary complications between the cohorts. Patients exposed to β-blockade versus no β-blockade experienced 13% and 22% mortality, respectively (p = 0.01). Stepwise logistic regression predicted the absence of β-blockade exposure as a risk factor for mortality (odds ratio, 2.7; 95% confidence interval, 1.5-4.8; p = 0.002). After adjustment for significant differences between the groups, patients not exposed to β-blockade experienced twofold increased risk of mortality (adjusted odds ratio, 2.2; 95% confidence interval, 1.3-3.7; p = 0.004).
Preinjury β-blockade improves survival following isolated severe TBI. The role of prophylactic β-blockade and the timing of initiation of such therapy after TBI warrant further investigations.
Therapeutic study, level III; prognostic study, level II.
本研究旨在探讨创伤性脑损伤（TBI）患者预先使用β受体阻滞剂的效果。我们假设 TBI 前使用β受体阻滞剂与存活率提高有关。
检索城市学术创伤中心的创伤登记处，以确定 2007 年 1 月至 2011 年 12 月期间患有孤立性严重 TBI 的患者。孤立性严重 TBI 的定义为颅内损伤，损伤严重程度评分（ISS）为 3 或更高，排除所有颅外损伤的 ISS 评分为 3 或更高。提取患者人口统计学、入院时的临床特征、损伤特征、ISS 评分、AIS 评分、院内发病率和β受体阻滞剂暴露情况进行分析。主要结局指标是根据预先使用β受体阻滞剂的情况进行分层的院内死亡率。
共有 662 名患者符合研究标准。其中，25%（n=159）在创伤前使用了β受体阻滞剂。在比较两组的人口统计学和损伤特征时，唯一的差异是年龄，β受体阻滞剂组年龄较大（69[12]岁 vs. 63[13]岁，p<0.001）。β受体阻滞剂组患者感染并发症发生率较高（30% vs. 19%，p=0.04），两组之间在心脏或肺部并发症方面无差异。接受β受体阻滞剂治疗的患者死亡率为 13%，未接受β受体阻滞剂治疗的患者死亡率为 22%（p=0.01）。逐步逻辑回归预测未使用β受体阻滞剂是死亡率的危险因素（优势比，2.7；95%置信区间，1.5-4.8；p=0.002）。在调整两组之间的显著差异后，未接受β受体阻滞剂治疗的患者死亡率增加了两倍（校正优势比，2.2；95%置信区间，1.3-3.7；p=0.004）。
预先使用β受体阻滞剂可提高孤立性严重 TBI 后的存活率。预防性β受体阻滞剂的作用以及在 TBI 后开始这种治疗的时间值得进一步研究。
治疗研究，III 级；预后研究，II 级。
