危重症外科患者长期异氟烷镇静与静脉镇静后的生存率：回顾性分析

Survival after long-term isoflurane sedation as opposed to intravenous sedation in critically ill surgical patients: Retrospective analysis.

作者信息

Bellgardt Martin, Bomberg Hagen, Herzog-Niescery Jenny, Dasch Burkhard, Vogelsang Heike, Weber Thomas P, Steinfort Claudia, Uhl Waldemar, Wagenpfeil Stefan, Volk Thomas, Meiser Andreas

机构信息

From the Department of Anaesthesiology and Intensive Care Medicine, St. Josef Hospital, Katholisches Klinikum Bochum, University Hospital, Ruhr-University of Bochum, Bochum (MB, JH-N, BD, HV, TPW), Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine, Saarland University Medical Centre, Homburg/Saar (HB, TV, AM), Department of Visceral and General Surgery, Katholisches Klinikum Bochum, Ruhr-University of Bochum, Bochum (CS, WU), Institute for Medical Biometry, Epidemiology and Medical Informatics, Saarland University Medical Centre, Homburg/Saar, Germany (SW).

出版信息

Eur J Anaesthesiol. 2016 Jan;33(1):6-13. doi: 10.1097/EJA.0000000000000252.

DOI:10.1097/EJA.0000000000000252

PMID:25793760

Abstract

BACKGROUND

Isoflurane has shown better control of intensive care sedation than propofol or midazolam and seems to be a useful alternative. However, its effect on survival remains unclear.

OBJECTIVE

The objective of this study is to compare mortality after sedation with either isoflurane or propofol/midazolam.

DESIGN

A retrospective analysis of data in a hospital database for a cohort of consecutive patients.

SETTING

Sixteen-bed interdisciplinary surgical ICU of a German university hospital.

PATIENTS

Consecutive cohort of 369 critically ill surgical patients defined within the database of the hospital information system. All patients were continuously ventilated and sedated for more than 96 h between 1 January 2005 and 31 December 2010. After excluding 169 patients (93 >79 years old, 10 <40 years old, 46 mixed sedation, 20 lost to follow-up), 200 patients were studied, 72 after isoflurane and 128 after propofol/midazolam.

INTERVENTIONS

Sedation with isoflurane using the AnaConDa system compared with intravenous sedation with propofol or midazolam.

MAIN OUTCOME MEASURES

Hospital mortality (primary) and 365-day mortality (secondary) were compared with the Kaplan-Meier analysis and a log-rank test. Adjusted odds ratios (ORs) [with 95% confidence interval (95% CI)] were calculated by logistic regression analyses to determine the risk of death after isoflurane sedation.

RESULTS

After sedation with isoflurane, the in-hospital mortality and 365-day mortality were significantly lower than after propofol/midazolam sedation: 40 versus 63% (P = 0.005) and 50 versus 70% (P = 0.013), respectively. After adjustment for potential confounders (coronary heart disease, chronic obstructive pulmonary disease, acute renal failure, creatinine, age and Simplified Acute Physiology Score II), patients after isoflurane were at a lower risk of death during their hospital stay (OR 0.35; 95% CI 0.18 to 0.68, P = 0.002) and within the first 365 days (OR 0.41; 95% CI 0.21 to 0.81, P = 0.010).

CONCLUSION

Compared with propofol/midazolam sedation, long-term sedation with isoflurane seems to be well tolerated in this group of critically ill patients after surgery.

摘要

背景

异氟烷在重症监护镇静控制方面比丙泊酚或咪达唑仑表现更好，似乎是一种有用的替代药物。然而，其对生存率的影响仍不明确。

目的

本研究的目的是比较异氟烷与丙泊酚/咪达唑仑镇静后的死亡率。

设计

对一家医院数据库中连续患者队列的数据进行回顾性分析。

地点

德国一家大学医院的16张床位的跨学科外科重症监护病房。

患者

医院信息系统数据库中定义的369例重症外科患者的连续队列。所有患者在2005年1月1日至2010年12月31日期间持续机械通气和镇静超过96小时。排除169例患者（93例年龄>79岁，10例年龄<40岁，46例混合镇静，20例失访）后，对200例患者进行研究，其中72例使用异氟烷镇静，128例使用丙泊酚/咪达唑仑镇静。

干预措施

使用AnaConDa系统进行异氟烷镇静，并与丙泊酚或咪达唑仑静脉镇静进行比较。

主要观察指标

采用Kaplan-Meier分析和对数秩检验比较医院死亡率（主要指标）和365天死亡率（次要指标）。通过逻辑回归分析计算调整后的比值比（OR）[及其95%置信区间（95%CI）]，以确定异氟烷镇静后死亡风险。

结果

异氟烷镇静后，院内死亡率和365天死亡率显著低于丙泊酚/咪达唑仑镇静后：分别为40%对63%（P = 0.005）和50%对70%（P = 0.013）。在对潜在混杂因素（冠心病、慢性阻塞性肺疾病、急性肾衰竭、肌酐、年龄和简化急性生理学评分II）进行调整后，异氟烷镇静的患者在住院期间死亡风险较低（OR 0.35；95%CI 0.18至0.68，P = 0.002），在最初365天内死亡风险也较低（OR 0.41；95%CI 0.21至0.81，P = 0.010）。