Nappi Jean M, Sieg Adam, Hassig Tanna B, Wahlquist Amy E
College of Pharmacy, Medical University of South Carolina, Charleston, South Carolina, USA.
Department of Pharmacy Services, Medical University of South Carolina, Charleston, South Carolina, USA.
Res Rev J Hosp Clin Pharm. 2016 May;2(2):87-91. Epub 2016 May 12.
With the previous norepinephrine shortage, alternative agents were required to treat patients with septic shock. This retrospective study evaluated whether the shortage of norepinephrine had an adverse effect on patients admitted to the intensive care unit with a diagnosis of severe sepsis or septic shock.
This was a retrospective chart review, which compared patients who received norepinephrine versus those who did not. Eligible patients were those ≥ 18 years old who were admitted to an intensive care unit with a diagnosis of sepsis and were initiated on a vasopressor to maintain hemodynamic stability. The specific primary endpoint was whether using norepinephrine versus other vasopressors had an effect on ICU length of stay. Secondary outcomes included mortality, blood pressure, mean arterial pressure, development of renal insufficiency, and vasopressor requirements.
There were 288 patients screened and 214 patients who met the inclusion criteria (norepinephrine group=106 and nonnorepinephrine group=108). After accounting for potential differences in disease severity (APACHE II score), age, weight and gender, there was no difference in ICU length of stay (p=0.4); however, the odds of survival were 5.9 (95% CI: 3.1 to 11.1) times higher for those in the non-norepinephrine group (p<0.0001).
Based on this retrospective analysis, patients that did not receive norepinephrine had a similar ICU LOS but had a higher rate of survival. The norepinephrine shortage did not have an adverse effect on patient outcomes.
鉴于之前去甲肾上腺素短缺，需要使用替代药物来治疗感染性休克患者。这项回顾性研究评估了去甲肾上腺素短缺是否对因严重脓毒症或感染性休克诊断而入住重症监护病房的患者产生不利影响。
这是一项回顾性病历审查，比较了接受去甲肾上腺素治疗的患者与未接受去甲肾上腺素治疗的患者。符合条件的患者为年龄≥18岁、因脓毒症诊断入住重症监护病房并开始使用血管升压药以维持血流动力学稳定的患者。具体的主要终点是使用去甲肾上腺素与其他血管升压药相比是否对重症监护病房住院时间有影响。次要结局包括死亡率、血压、平均动脉压、肾功能不全的发生情况以及血管升压药的需求。
共筛查了288例患者，214例符合纳入标准（去甲肾上腺素组=106例，非去甲肾上腺素组=108例）。在考虑疾病严重程度（急性生理与慢性健康状况评分系统II [APACHE II] 评分）、年龄、体重和性别等潜在差异后，重症监护病房住院时间无差异（p = 0.4）；然而，非去甲肾上腺素组患者的生存几率是非去甲肾上腺素组的5.9倍（95%可信区间：3.1至11.1）（p < 0.0001）。
基于这项回顾性分析，未接受去甲肾上腺素治疗的患者重症监护病房住院时间相似，但生存率更高。去甲肾上腺素短缺对患者结局没有不利影响。
