脓毒性休克中去甲肾上腺素使用与心律失常的预测因素。

Predictors of dysrhythmias with norepinephrine use in septic shock.

机构信息

Department of Pharmacy, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA; Department of Pharmacy, Methodist University Hospital, 1265 Union Avenue, Memphis, TN 38104, USA.

Department of Pharmacy, Methodist University Hospital, 1265 Union Avenue, Memphis, TN 38104, USA; University of Tennessee Health Sciences Center, Department of Clinical Pharmacy and Translational Science, 910 Madison Avenue, Memphis, TN 38163, USA; University of Tennessee Health Sciences Center, Neurology and Neurosurgery, 910 Madison Avenue, Memphis, TN 38163, USA.

出版信息

J Crit Care. 2021 Feb;61:133-137. doi: 10.1016/j.jcrc.2020.10.023. Epub 2020 Oct 28.

DOI:10.1016/j.jcrc.2020.10.023

PMID:33160177

Abstract

PURPOSE

Norepinephrine (NE) is recommended first-line for treatment of septic shock, partly due to its intrinsically low effect on heart rate. While dysrhythmias secondary to NE are still reported, factors associated with development of this adverse effect have not been described. Our study sought to investigate factors associated with dysrhythmias in patients receiving NE for septic shock.

MATERIALS AND METHODS

We conducted a retrospective cohort study of adults receiving NE for septic shock if NE was initiated as the first vasopressor and continued for at least 6 h. The primary objective was to determine the rate of dysrhythmias among this patient population. Secondary objectives included determining the effect of dysrhythmia development on patient outcomes and elucidating predictors for dysrhythmia development.

RESULTS

Of the 250 patients included, 34.4% (n = 86) developed a dysrhythmia. These patients had higher mortality (30.5% vs. 63.9%; p < 0.001) with decreased ICU-free days (2 vs. 4; p = 0.04) and ventilator-free days (7 vs. 4; p = 0.048). Duration of NE infusion and maximum NE dose were found to be independently associated with increased rates of dysrhythmia (p < 0.005).

CONCLUSION

Development of dysrhythmia is associated with increased mortality and is independently associated with longer duration of NE infusion and higher NE doses.

摘要

目的

去甲肾上腺素（NE）被推荐作为治疗感染性休克的一线药物，部分原因是其对心率的影响较小。尽管仍有报道称 NE 会引起心律失常，但尚未描述与这种不良反应发生相关的因素。我们的研究旨在探讨接受 NE 治疗感染性休克的患者发生心律失常的相关因素。

材料与方法

我们进行了一项回顾性队列研究，纳入了接受 NE 治疗感染性休克的成年人，如果 NE 作为首选用药并持续至少 6 小时。主要目的是确定该患者人群中心律失常的发生率。次要目标包括确定心律失常的发生对患者结局的影响，并阐明心律失常发生的预测因素。

结果

在纳入的 250 名患者中，34.4%（n=86）发生了心律失常。这些患者的死亡率更高（30.5% vs. 63.9%；p<0.001），ICU 无天数（2 天 vs. 4 天；p=0.04）和呼吸机无天数（7 天 vs. 4 天；p=0.048）更少。NE 输注时间和最大 NE 剂量与心律失常发生率增加独立相关（p<0.005）。