去甲肾上腺素联合苯肾上腺素与去甲肾上腺素治疗脓毒性休克患者的回顾性队列研究。

Norepinephrine combined with phenylephrine versus norepinephrine in patients with septic shock: a retrospective cohort study.

机构信息

Department of Intensive Care Unit, The First Affiliated Hospital of Jinan University, Guangzhou, China.

Department of Anesthesiology, Hengyang Maternal and Child Health Hospital, Hengyang, China.

出版信息

BMC Infect Dis. 2023 Apr 7;23(1):221. doi: 10.1186/s12879-023-08142-x.

DOI:10.1186/s12879-023-08142-x

PMID:37029365

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10082526/

Abstract

BACKGROUND

Phenylephrine (PE) and norepinephrine (NE) may be used to maintain adequate blood pressure and tissue perfusion in patients with septic shock, but the effect of NE combined with PE (NE-PE) on mortality remains unclear. We hypothesized that NE-PE would not inferior to NE alone for all-cause hospital mortality in patients with septic shock.

METHODS

This single-center, retrospective cohort study included adult patients with septic shock. According to the infusion type, patients were divided into the NE-PE or NE group. Multivariate logistic regression, propensity score matching and doubly robust estimation were used to analyze the differences between groups. The primary outcome was the all-cause hospital mortality rate after NE-PE or NE infusion.

RESULTS

Among 1, 747 included patients, 1, 055 received NE and 692 received NE-PE. For the primary outcome, the hospital mortality rate was higher in patients who received NE-PE than in those who received NE (49.7% vs. 34.5%, p < 0.001), and NE-PE was independently associated with higher hospital mortality (odds ratio = 1.76, 95% confidence interval = 1.36-2.28, p < 0.001). Regarding secondary outcomes, patients in the NE-PE group had longer lengths of stay in ICU and hospitals. Patients in the NE-PE group also received mechanical ventilation for longer durations.

CONCLUSIONS

NE combined with PE was inferior to NE alone in patients with septic shock, and it was associated with a higher hospital mortality rate.

摘要

背景

去甲肾上腺素（NE）和苯肾上腺素（PE）可用于维持感染性休克患者的血压和组织灌注，但联合应用 NE 和 PE（NE-PE）对死亡率的影响尚不清楚。我们假设 NE-PE 不会降低感染性休克患者的全因住院死亡率。

方法

这项单中心、回顾性队列研究纳入了成年感染性休克患者。根据输注类型，患者分为 NE-PE 或 NE 组。采用多变量逻辑回归、倾向评分匹配和双重稳健估计来分析组间差异。主要结局为 NE-PE 或 NE 输注后全因住院死亡率。

结果

在纳入的 1747 例患者中，1055 例接受 NE 治疗，692 例接受 NE-PE 治疗。对于主要结局，接受 NE-PE 治疗的患者住院死亡率高于接受 NE 治疗的患者（49.7% vs. 34.5%，p<0.001），且 NE-PE 与更高的住院死亡率独立相关（比值比=1.76，95%置信区间=1.36-2.28，p<0.001）。关于次要结局，NE-PE 组患者 ICU 和医院的住院时间更长。NE-PE 组患者也接受了更长时间的机械通气。