Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea.
Department of Statistics, Keimyung University, Daegu, Korea.
Yonsei Med J. 2024 Dec;65(12):695-702. doi: 10.3349/ymj.2024.0180.
Intravenous (IV) acetaminophen-induced hypotension is a clinically significant issue that remains difficult to predict. Therefore, this study aimed to identify the factors associated with hypotension in patients with repeated IV acetaminophen administration.
This observational cohort study included patients who received IV acetaminophen in the critical care unit of the Yongin Severance Hospital in 2020. All IV acetaminophen administration records for each patient were reviewed, and the blood pressure records within 2 h after IV acetaminophen administration were examined. Changes in blood pressure within 2 h of IV acetaminophen administration were monitored to identify hypotension, defined as a systolic blood pressure <90 mm Hg, a decrease in systolic blood pressure by 30 mm Hg, or a decrease in mean arterial pressure by 15%.
There were 1547 instances of IV acetaminophen administration among 398 patients. Of these, 416 instances (26.9%) resulted in hypotension among 204 patients (51.3%). A history of IV acetaminophen-induced hypotension did not predict subsequent hypotensive episodes, and there was no consistent tendency. The use of beta-blocker [odds ratio (OR)=1.50], gastrointestinal (GI) infection (OR=1.42), and septic shock (OR=1.68) were significant risk factors for IV acetaminophen-induced hypotension in multivariate analysis. In subgroup analysis of cases with beta-blocker, heart failure (OR=1.91), urinary tract infection (OR=2.16), GI infection (OR=1.83) were significant risk factors.
Severe infections, heart failure, and the use of beta-blockers are associated with IV acetaminophen-induced hypotension. However, IV acetaminophen-induced hypotension is inconsistent and depends on the patient's condition.
静脉（IV）给予对乙酰氨基酚引起的低血压是一个临床显著的问题，仍然难以预测。因此，本研究旨在确定与重复 IV 给予对乙酰氨基酚相关的低血压患者的相关因素。
本观察性队列研究纳入了 2020 年在 Yongin Severance 医院重症监护病房接受 IV 对乙酰氨基酚治疗的患者。回顾每位患者的所有 IV 对乙酰氨基酚给药记录，并检查 IV 对乙酰氨基酚给药后 2 小时内的血压记录。监测 IV 对乙酰氨基酚给药后 2 小时内的血压变化，以确定低血压，定义为收缩压<90mmHg，收缩压下降 30mmHg 或平均动脉压下降 15%。
398 例患者中有 1547 例接受了 IV 对乙酰氨基酚治疗。其中，204 例（51.3%）患者中有 416 例（26.9%）出现低血压。IV 对乙酰氨基酚引起的低血压病史不能预测随后的低血压发作，且无一致趋势。β受体阻滞剂（OR=1.50）、胃肠道（GI）感染（OR=1.42）和感染性休克（OR=1.68）的使用是 IV 对乙酰氨基酚引起的低血压的多变量分析中的显著危险因素。在使用β受体阻滞剂的亚组分析中，心力衰竭（OR=1.91）、尿路感染（OR=2.16）和 GI 感染（OR=1.83）是显著的危险因素。
严重感染、心力衰竭和β受体阻滞剂的使用与 IV 对乙酰氨基酚引起的低血压有关。然而，IV 对乙酰氨基酚引起的低血压是不一致的，取决于患者的病情。
