Komatsu Ryu, Makarova Natalya, You Jing, Sessler Daniel I, Anthony David G, Kasuya Yusuke, Soltesz Edward G, Turan Alparslan
Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA.
Departments of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH; Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH.
J Cardiothorac Vasc Anesth. 2016 Dec;30(6):1516-1522. doi: 10.1053/j.jvca.2016.04.022. Epub 2016 Apr 28.
To compare incidence of atrial arrhythmia, duration of care, and major complications after cardiac surgery between patients who received etomidate and those who received other induction agents.
Retrospective cohort study utilizing propensity score matching.
A single academic, tertiary care hospital.
Eight thousand nine hundred seventy-eight patients undergoing coronary artery bypass grafting (CABG), valve, or combined valve/CABG surgery requiring cardiopulmonary bypass between January 2005 and December 2010.
Patients were divided into those who received etomidate at anesthetic induction and those who received another induction agent. Patients given etomidate were propensity-score matched to patients given other induction agents in a 2:1 ratio.
Of 8,978 patients who underwent CABG, valve, or combined valve/surgery, 6,313 received etomidate and 2,665 received other induction agents. Among these, the authors successfully matched 4,094 etomidate patients with 2,524 non-etomidate patients. The authors did not find a significant association between receiving etomidate and odds of experiencing postoperative atrial arrhythmia (odds ratio [98.3% confidence interval] of 1.07 [0.92, 1.23], p = 0.29). Etomidate was not associated significantly with either intensive care unit or hospital stay. Etomidate was associated significantly with use of packed red blood cells (odds ratio [99.6% confidence interval] of 1.32 [1.02, 1.70], p = 0.002), but not with use of fresh frozen plasma, platelets, or cryoprecipitate. None of the other complications differed significantly between the groups.
Etomidate was not associated with increased incidence of postoperative atrial arrhythmia or increased intensive care unit or hospital stay.
比较接受依托咪酯的患者与接受其他诱导剂的患者心脏手术后房性心律失常的发生率、护理时长及主要并发症。
采用倾向评分匹配的回顾性队列研究。
一家单一的学术性三级护理医院。
2005年1月至2010年12月期间8978例接受冠状动脉旁路移植术（CABG）、瓣膜手术或瓣膜/CABG联合手术且需要体外循环的患者。
患者被分为麻醉诱导时接受依托咪酯的患者和接受其他诱导剂的患者。接受依托咪酯的患者与接受其他诱导剂的患者按2:1的比例进行倾向评分匹配。
在8978例接受CABG、瓣膜手术或联合手术的患者中，6313例接受依托咪酯，2665例接受其他诱导剂。其中，作者成功将4094例依托咪酯治疗患者与2524例非依托咪酯治疗患者进行了匹配。作者未发现接受依托咪酯与术后房性心律失常几率之间存在显著关联（优势比[98.3%置信区间]为1.07[0.92,1.23]，p = 0.29）。依托咪酯与重症监护病房或住院时长均无显著关联。依托咪酯与浓缩红细胞的使用显著相关（优势比[99.6%置信区间]为1.32[1.02,1.70]，p = 0.002），但与新鲜冰冻血浆、血小板或冷沉淀的使用无关。两组间其他并发症均无显著差异。
依托咪酯与术后房性心律失常发生率增加、重症监护病房或住院时长增加均无关联。
