Patanwala Asad E, Erstad Brian L, Roe Denise J, Sakles John C
Department of Pharmacy Practice & Science, College of Pharmacy, The University of Arizona, Tucson, Arizona.
Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, Arizona.
Pharmacotherapy. 2016 Jan;36(1):57-63. doi: 10.1002/phar.1683.
To compare succinylcholine and rocuronium regarding mortality in patients with traumatic brain injury (TBI) who are intubated in the emergency department (ED).
This was a retrospective cohort study conducted in an academic ED in the United States. Adult patients with TBI who underwent rapid sequence intubation (RSI) in the ED with rocuronium or succinylcholine between October 2010 and October 2014 were included. The main outcome of interest was in-hospital mortality. Subjects were stratified based on severity of injury using head abbreviated injury scores. The high-severity group had a severe or critical head injury (score 4 or higher); the low-severity group had a less than severe head injury (score lower than 4).
The final study cohort included 233 patients who were underwent RSI with succinylcholine (149 patients) or rocuronium (84 patients). In patients who received rocuronium, mortality was 22% (12/54) and 23% (7/30) in the low-severity and high-severity categories, respectively (difference 1%, 95% confidence interval [CI] -18% to 20%). In patients who received succinylcholine, mortality was 14% (14/103) and 44% (20/46) in the low-severity and high-severity categories, respectively (difference 30%, 95% CI 14-46). In the multivariate analysis after adjusting for important confounders, there was no significant association between succinylcholine and mortality in the low-severity category (odds ratio [OR] 0.75, 95% CI 0.29-1.92). However, in patients in the high-severity category, succinylcholine was associated with increased mortality compared with rocuronium (OR 4.10, 95% CI 1.18-14.12).
In severely brain-injured patients undergoing RSI in the ED, succinylcholine was associated with increased mortality compared with rocuronium.
比较琥珀酰胆碱和罗库溴铵在急诊科（ED）接受气管插管的创伤性脑损伤（TBI）患者中的死亡率。
这是一项在美国一家学术性急诊科进行的回顾性队列研究。纳入2010年10月至2014年10月期间在急诊科接受快速序贯诱导插管（RSI）且使用罗库溴铵或琥珀酰胆碱的成年TBI患者。主要关注的结局是院内死亡率。使用头部简明损伤评分根据损伤严重程度对受试者进行分层。高严重度组为严重或极重度颅脑损伤（评分4分或更高）；低严重度组为轻度以下颅脑损伤（评分低于4分）。
最终研究队列包括233例接受RSI的患者，其中使用琥珀酰胆碱的有149例，使用罗库溴铵的有84例。接受罗库溴铵的患者中，低严重度组和高严重度组的死亡率分别为22%（12/54）和23%（7/30）（差异1%，95%置信区间[CI] -18%至20%）。接受琥珀酰胆碱的患者中，低严重度组和高严重度组的死亡率分别为14%（14/103）和44%（20/46）（差异30%，95% CI 14 - 46）。在对重要混杂因素进行校正后的多变量分析中，低严重度组中琥珀酰胆碱与死亡率之间无显著关联（比值比[OR] 0.75，95% CI 0.29 - 1.92）。然而，在高严重度组患者中，与罗库溴铵相比，琥珀酰胆碱与死亡率增加相关（OR 4.10，95% CI 1.18 - 14.12）。
在急诊科接受RSI的重度脑损伤患者中，与罗库溴铵相比，琥珀酰胆碱与死亡率增加相关。
