罂粟摘要【应用倾向性评分法评估右美托咪定对创伤性脑损伤预后的影响】

应用倾向性评分法评估右美托咪定对创伤性脑损伤预后的影响

贵州医科大学    麻醉与心脏电生理课题组

翻译：张中伟  编辑：马艳燕  审校：曹莹

背景：右美托咪定在动物实验中被证实对创伤性脑损伤(TBI)具有保护作用，并且在先前的临床研究中被证明是安全的，但它是否能改善脑损伤患者的生存质量仍有待确定。我们试图通过分析来自MIMIC临床数据库的数据来回答这个问题。

方法：从MIMIC III和MIMIC IV数据库中提取创伤性脑损伤(TBI)患者的数据，并将其分为右美托咪定组和对照组。前者用右美托咪定镇静，后者不使用右美托咪定。将患者年龄、急性生理学评分III、格拉斯哥昏迷分级、其他镇静剂使用情况、24小时内的瞳孔反应等参数用于倾向性评分分析，以达到组间平衡进行进一步分析。采用Kaplan-Meier生存分析法对患者的住院生存率和6个月生存率进行统计学分析，并采用对数秩检验进行比较。生存资料的单因素分析、多因素分析、倾向配对分析和逆治疗概率加权分析重复使用COX回归。同时，还分析了低血压、心动过缓、感染和癫痫发作对预后的影响。

结果：不同类型的生存分析显示出相同的趋势。右美托咪定显著提高了TBI患者的存活率。它没有引起更多的低血压、感染和癫痫的发作。低血压与住院死亡率无关，但与6个月死亡率显著相关。

结论：右美托咪定可提高脑外伤患者的存活率，但使用时应小心避免低血压。

原始文献来源：Jinbu Xu and Qing Xiao.Assessment of the effects of dexmedetomidine on outcomes of traumatic brain injury using propensity score analysis.[J]. BMC Anesthesiol(2022) 22:280

英文原文      

Assessment of the effects of dexmedetomidine on outcomes of traumatic brain injury using propensity score analysis

Background: Dexmedetomidine was found to be protective against traumatic brain injury (TBI) in animal studies and safe for use in previous clinical studies, but whether it improves TBI patient survival remains to be determined. We sought to answer this question by analyzing data from the MIMIC clinical database.

Methods:Data for TBI patients from the MIMIC III and MIMIC IV databases were extracted and divided into a dexmedetomidine group and a control group. In the former group, dexmedetomidine was used for sedation, while in the latter, it was not used. Parameters including patient age, the Acute Physiology score III, the Glasgow Coma Scale, other sedatives used, and pupillary response within 24 h were employed in propensity score matching to achieve a balance between groups for further analysis. In-hospital survival and 6-month survival were analyzed by Kaplan–Meier survival analysis and compared by log-rank test. Cox regression was used repeatedly for the univariate analysis, the multivariate analysis, the propensity score-matched analysis, and the inverse probability of treatment weighted analysis of survival data. Meanwhile, the influences of hypotension, bradycardia, infection, and seizure on outcome were also analyzed.

Results: Different types of survival analyses demonstrated the same trend. Dexmedetomidine significantly improved TBI patient survival. It caused no more incidents of hypotension, infection, and seizure. Hypotension was not correlated with in-hospital mortality, but was significantly correlated with 6-month mortality.

Conclusions:Dexmedetomidine may improve the survival of TBI patients. It should be used with careful avoidance of hypotension.

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