Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan.
Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
Crit Care Med. 2020 May;48(5):e356-e361. doi: 10.1097/CCM.0000000000004255.
Previous studies have suggested that vasodilator therapy may be beneficial for patients with nonocclusive mesenteric ischemia. However, robust evidence supporting this contention is lacking. We examined the hypothesis that vasodilator therapy may be effective in patients diagnosed with nonocclusive mesenteric ischemia.
Retrospective cohort study.
The Japanese Diagnosis Procedure Combination inpatient database.
A total of 1,837 patients with nonocclusive mesenteric ischemia from July 2010 to March 2018.
None.
We compared patients who received vasodilator therapy (vasodilator group; n = 161) and those who did not (control group; n = 1,676) using one-to-four propensity score matching. Vasodilator therapy was defined as papaverine and/or prostaglandin E1 administered via venous and/or arterial routes within 2 days of admission. Only patients who did not receive abdominal surgery within 2 days of admission were analyzed. The main outcomes were in-hospital mortality and abdominal surgery performed greater than or equal to 3 days after admission. After propensity score matching, in-hospital mortality was significantly lower in the vasodilator group (risk difference, -11.6%; p = 0.005). The proportion of patients who received abdominal surgery at greater than or equal to 3 days after admission was also significantly lower in the vasodilator group (risk difference, -10.2%; p = 0.002).
Vasodilator therapy with papaverine and/or prostaglandin E1 is associated with lower in-hospital mortality and prevalence of abdominal surgery in patients with nonocclusive mesenteric ischemia.
先前的研究表明，血管扩张剂治疗可能对非闭塞性肠系膜缺血患者有益。然而，缺乏支持这一观点的有力证据。我们检验了血管扩张剂治疗可能对非闭塞性肠系膜缺血患者有效的假设。
回顾性队列研究。
日本诊断程序组合住院数据库。
2010 年 7 月至 2018 年 3 月期间共 1837 例非闭塞性肠系膜缺血患者。
无。
我们使用 1:4 倾向评分匹配比较了接受血管扩张剂治疗的患者（血管扩张剂组；n = 161）和未接受治疗的患者（对照组；n = 1676）。血管扩张剂治疗定义为入院后 2 天内通过静脉和/或动脉途径给予罂粟碱和/或前列腺素 E1。仅分析入院后 2 天内未行腹部手术的患者。主要结局为住院期间死亡率和入院后 3 天以上行腹部手术。在倾向评分匹配后，血管扩张剂组的住院期间死亡率显著降低（风险差异，-11.6%；p = 0.005）。血管扩张剂组在入院后 3 天以上行腹部手术的患者比例也显著降低（风险差异，-10.2%；p = 0.002）。
在非闭塞性肠系膜缺血患者中，使用罂粟碱和/或前列腺素 E1 的血管扩张剂治疗与较低的住院期间死亡率和腹部手术发生率相关。
