β受体阻滞剂与单纯严重颅外损伤的转归改善无关：一项观察性队列研究。
Beta-blockade is not associated with improved outcomes in isolated severe extracranial injury: an observational cohort study.
机构信息
Department of Surgery, Capio St Görans Hospital, Stockholm, Sweden.
Department of Surgery, Örebro University Hospital, Örebro, Sweden.
出版信息
Scand J Trauma Resusc Emerg Med. 2021 Sep 8;29(1):132. doi: 10.1186/s13049-021-00947-6.
BACKGROUND
There is evidence supporting the use of beta-blockade in patients with traumatic brain injury. The reduction in sympathetic drive is thought to underlie the relationship between beta-blockade and increased survival. There is little evidence for similar effects in extracranial injuries. This study aimed to assess the association between beta-blockade and survival in patients suffering isolated severe extracranial injuries.
METHODS
Patients treated at an academic urban trauma centre during a 5-year period were retrospectively identified. Adults suffering isolated severe extracranial injury [Injury Severity Score (ISS) ≥ 16 with Abbreviated Injury Score of ≤ 2 for any intracranial injury] were included. Patient characteristics and outcomes were collected from the trauma registry and hospital medical records. Patients were subdivided into beta-blocker exposed and unexposed groups. Patients were matched using propensity score matching. Differences were assessed using McNemar's or paired Student's t test. The primary outcome of interest was 90-day mortality and secondary outcome was in-hospital complications.
RESULTS
698 patients were included of whom 10.5% were on a beta-blocker. Most patients suffered blunt force trauma (88.5%) with a mean [standard deviation] ISS of 24.6 [10.6]. Unadjusted mortality was higher in patients receiving beta-blockers (34.2% vs. 9.1%, p < 0.001) as were cardiac complications (8.2% vs. 1.4%, p = 0.002). Patients on beta-blockers were significantly older (69.5 [14.1] vs. 43.2 [18.0] years) and of higher comorbidity. After matching, no statistically significant differences were seen in 90-day mortality (34.2% vs. 30.1%, p = 0.690) or in-hospital complications.
CONCLUSIONS
Beta-blocker therapy does not appear to be associated with improved survival in patients with isolated severe extracranial injuries.
背景
有证据支持在创伤性脑损伤患者中使用β受体阻滞剂。交感神经驱动的减少被认为是β受体阻滞剂与存活率增加之间的关系基础。在颅外损伤中，类似的效果证据很少。本研究旨在评估β受体阻滞剂与单纯严重颅外损伤患者生存的关系。
方法
回顾性分析了在 5 年内接受学术性城市创伤中心治疗的患者。纳入的患者为单纯严重颅外损伤[损伤严重程度评分（ISS）≥16 且任何颅内损伤的简明损伤评分≤2]。从创伤登记处和医院病历中收集患者特征和结局。将患者分为β受体阻滞剂暴露组和未暴露组。使用倾向评分匹配进行匹配。使用 McNemar 或配对学生 t 检验评估差异。主要观察终点为 90 天死亡率，次要观察终点为院内并发症。
结果
共纳入 698 例患者，其中 10.5%使用β受体阻滞剂。大多数患者遭受钝器伤（88.5%），ISS 平均值[标准差]为 24.6[10.6]。使用β受体阻滞剂的患者未调整死亡率更高（34.2%比 9.1%，p<0.001），心脏并发症发生率更高（8.2%比 1.4%，p=0.002）。使用β受体阻滞剂的患者年龄明显更大（69.5[14.1]岁比 43.2[18.0]岁），合并症更多。匹配后，90 天死亡率（34.2%比 30.1%，p=0.690）或院内并发症无统计学显著差异。
结论
β受体阻滞剂治疗似乎与单纯严重颅外损伤患者的生存率提高无关。
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