From the Departments of Anesthesiology and Pain Medicine (J.B.S.) and Neurology (D.L.T., K.J.B.), University of Washington, Seattle.
Stroke. 2017 Oct;48(10):2693-2698. doi: 10.1161/STROKEAHA.117.017230. Epub 2017 Sep 13.
Increased sympathetic tone causes hypertension after intracerebral hemorrhage, and blood pressure reduction has been studied as a way to decrease hemorrhage growth and improve outcomes. It is unknown if the antihypertensive used to achieve blood pressure goals influences either. Because sympatholytic drugs reduce death and infection in animal models, we hypothesized that labetalol would improve outcomes compared with nicardipine.
Prospective data from a single center were retrospectively reviewed. Patients receiving labetalol, nicardipine, or both during their first 3 days of hospitalization were included. Outcomes included in-hospital death; discharge modified Rankin Score >2; and in-hospital urinary tract infection, pneumonia, or bacteremia. Patients were compared with propensity scoring and analyzed with linear models adjusted for significant confounders.
Of 1066 admissions, 525 were treated with labetalol or nicardipine and are included; 229 (43.6%) received labetalol, 107 (20.4%) received nicardipine, and 189 (36.0%) received both. Mortality and infection rates were 40.2% and 15.8%, respectively, 77.2% had a modified Rankin Score >2. After adjustment, compared with nicardipine alone, labetalol alone was associated with infection (odds ratio, 3.12; confidence interval, 1.27-7.64; =0.013) but not when combined with nicardipine (odds ratio, 2.44; confidence interval, 0.98-6.07; =0.055). Labetalol, with or without nicardipine, was not associated with death or discharge modified Rankin Score >2.
Compared with nicardipine, labetalol was associated with increased in-hospital infections, but not mortality or modified Rankin Score >2. These findings do not support our hypothesis that labetalol use improves outcomes relative to nicardipine in intracerebral hemorrhage.
脑出血后交感神经张力增加会导致高血压，因此降低血压已被研究作为减少出血和改善预后的一种方法。目前尚不清楚用于达到血压目标的降压药物是否会产生影响。由于交感神经抑制剂可降低动物模型的死亡率和感染率，我们假设拉贝洛尔的效果会优于尼卡地平。
对一家中心的前瞻性数据进行回顾性分析。将在住院前 3 天内接受拉贝洛尔、尼卡地平或两者治疗的患者纳入研究。观察指标包括院内死亡、出院时改良 Rankin 评分>2 分以及院内尿路感染、肺炎或菌血症。通过倾向评分法进行患者比较，并采用线性模型进行分析，模型中调整了显著混杂因素。
在 1066 例住院患者中，525 例接受了拉贝洛尔或尼卡地平治疗，包括 229 例（43.6%）接受拉贝洛尔、107 例（20.4%）接受尼卡地平、189 例（36.0%）接受两者联合治疗。死亡率和感染率分别为 40.2%和 15.8%，77.2%的患者改良 Rankin 评分>2 分。调整混杂因素后，与单纯使用尼卡地平相比，单纯使用拉贝洛尔与感染（比值比，3.12；95%置信区间，1.27-7.64；=0.013）相关，但与尼卡地平联合使用时则不相关（比值比，2.44；95%置信区间，0.98-6.07；=0.055）。无论是否联合使用尼卡地平，拉贝洛尔都与院内死亡或出院时改良 Rankin 评分>2 分无关。
与尼卡地平相比，拉贝洛尔与院内感染发生率增加相关，但与死亡率或改良 Rankin 评分>2 分无关。这些结果不支持我们的假设，即与尼卡地平相比，拉贝洛尔在脑出血患者中的使用效果会更好。
