β受体阻滞剂能否降低单纯严重颅外损伤患者患抑郁症的风险？
Does Beta-Blockade Reduce the Risk of Depression in Patients with Isolated Severe Extracranial Injuries?
作者信息
Ahl Rebecka, Barmparas Galinos, Riddez Louis, Ley Eric J, Wallin Göran, Ljungqvist Olle, Mohseni Shahin
机构信息
School of Medical Sciences, Orebro University, Fakultetsgatan 1, 702 81, Orebro, Sweden.
Division of Trauma and Emergency Surgery, Department of Surgery, Karolinska University Hospital, 171 76, Solna, Stockholm, Sweden.
出版信息
World J Surg. 2017 Jul;41(7):1801-1806. doi: 10.1007/s00268-017-3935-5.
BACKGROUND
Approximately half of trauma patients develop post-traumatic depression. It is suggested that beta-blockade impairs trauma memory recollection, reducing depressive symptoms. This study investigates the effect of early beta-blockade on depression following severe traumatic injuries in patients without significant brain injury.
METHODS
Patients were identified by retrospectively reviewing the trauma registry at an urban university hospital between 2007 and 2011. Severe extracranial injuries were defined as extracranial injuries with Abbreviated Injury Scale score ≥3, intracranial Abbreviated Injury Scale score <3 and an Injury Severity Score ≥16. In-hospital deaths and patients prescribed antidepressant therapy ≤1 year prior to admission were excluded. Patients were stratified into groups based on pre-admission beta-blocker status. The primary outcome was post-traumatic depression, defined as receiving antidepressants ≤1 year following trauma.
RESULTS
Five hundred and ninety-six patients met the inclusion criteria with 11.4% prescribed pre-admission beta-blockade. Patients receiving beta-blockers were significantly older (57 ± 18 vs. 42 ± 17 years, p < 0.001) with lower Glasgow Coma Scale score (12 ± 3 vs. 14 ± 2, p < 0.001). The beta-blocked cohort spent significantly longer in hospital (21 ± 20 vs. 15 ± 17 days, p < 0.01) and intensive care (4 ± 7 vs. 3 ± 5 days, p = 0.01). A forward logistic regression model was applied and predicted lack of beta-blockade to be associated with increased risk of depression (OR 2.7, 95% CI 1.1-7.2, p = 0.04). After adjusting for group differences, patients lacking beta-blockers demonstrated an increased risk of depression (AOR 3.3, 95% CI 1.2-8.6, p = 0.02).
CONCLUSIONS
Pre-admission beta-blockade is associated with a significantly reduced risk of depression following severe traumatic injury. Further investigation is needed to determine the beneficial effects of beta-blockade in these instances.
背景
约半数创伤患者会发生创伤后抑郁。有研究表明，β受体阻滞剂会损害创伤记忆的回忆，从而减轻抑郁症状。本研究旨在调查早期使用β受体阻滞剂对无严重脑损伤的严重创伤患者创伤后抑郁的影响。
方法
通过回顾性查阅2007年至2011年间一家城市大学医院的创伤登记资料来确定研究对象。严重颅外损伤定义为简明损伤定级标准（AIS）评分≥3的颅外损伤、颅内AIS评分<3且损伤严重程度评分（ISS）≥16。排除院内死亡患者以及入院前≤1年曾接受抗抑郁治疗的患者。根据入院前β受体阻滞剂使用情况将患者分层。主要结局指标为创伤后抑郁，定义为创伤后≤1年接受抗抑郁药物治疗。
结果
596例患者符合纳入标准，其中11.4%的患者入院前使用了β受体阻滞剂。使用β受体阻滞剂的患者年龄显著更大（57±18岁 vs. 42±17岁，p<0.001），格拉斯哥昏迷量表评分更低（12±3 vs. 14±2，p<0.001）。使用β受体阻滞剂的患者住院时间显著更长（21±20天 vs. 15±17天，p<0.01），在重症监护病房的时间也更长（4±7天 vs. 3±5天，p=0.01）。应用向前逻辑回归模型预测，未使用β受体阻滞剂与抑郁风险增加相关（比值比[OR]2.7，95%置信区间[CI]1.1 - 7.（此处原文有误，应为7.2），p=0.04）。在对组间差异进行校正后，未使用β受体阻滞剂的患者抑郁风险增加（校正后比值比[AOR]3.3，95%CI 1.2 - 8.6，p=0.02）。
结论
入院前使用β受体阻滞剂与严重创伤后抑郁风险显著降低相关。需要进一步研究以确定β受体阻滞剂在这些情况下的有益作用。
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