Crit Care:急性呼吸窘迫综合征(ARDS)的COVID-19患者早期短疗程神经肌肉阻断剂的治疗效果

2022-05-22 MedSci原创 MedSci原创

对于中重度急性呼吸窘迫综合征(ARDS)的COVID-19患者,早期开始NMBA短程治疗并没有显著改善患者90天死亡率和VFD。在缺乏来自临床试验的明确数据的情况下,这类患者应谨慎使用NMBA。

神经肌肉阻滞药(NMBA)在2019冠状病毒病 (COVID-19)急性呼吸窘迫综合征(ARDS)患者中的作用尚未完全阐明。近日,危重病医学领域权威杂志Critical Care上发表了一篇研究文章,研究人员旨在通过倾向评分(PS)匹配分析,以调查中至重度ARDS的COVID-19患者早期使用NMBA对90天死亡率的影响。

研究人员分析了2020年2月1日至2021年10月31日期间COVID-19重症监护联盟中244个重症监护病房收治的中至重度急性呼吸窘迫综合征COVID-19患者的样本。在有创机械通气(IMV)开始后48小时内接受至少2天至3天NMBA (NMBA治疗)的患者与未接受NMBA治疗或仅开始IMV的患者(对照组)进行了比较。PS-匹配队列的主要目标是通过Cox比例风险模型评估了各组间90天住院死亡率。该研究的次要结局是通过竞争风险回归比较的第1天至第28天和第1天至第90天的无呼吸机天数(VFD)。

该研究纳入了1953例患者的数据。通过倾向评分匹配,每组210例患者进行了良好的匹配。在PS匹配队列中,患者平均(±SD)年龄为60.3±13.2岁,296名(70.5%)为男性,最常见的合并症为高血压(56.9%)、肥胖(41.1%)和糖尿病(30.0%)。

NMBA治疗组与对照组的未校正的90天死亡风险比为(HR)为1.12 (95%CI为0.79-1.59, p=0.534)。在调整吸烟习惯和关键治疗协变量后,风险比为1.07 (95%CI为0.72-1.61, p=0.729)。28天时,NMBA治疗组和对照组的VFD分别为16天(IQR为0-25)和25天(IQR为7-26)(亚风险比为0.82,95%CI为0.67-1.00, p=0.055)。90天时,VFD分别为77天(IQR为0-87)和87天(IQR为0-88)(亚风险比为0.86 (95%CI为0.69-1.07;p=0.177)。

由此可见,对于中重度急性呼吸窘迫综合征(ARDS)的COVID-19患者,早期开始NMBA短程治疗并没有显著改善患者90天死亡率和VFD。在缺乏来自临床试验的明确数据的情况下,这类患者应谨慎使用NMBA。

原始出处:

Gianluigi Li Bassi,et al.Early short course of neuromuscular blocking agents in patients with COVID-19 ARDS: a propensity score analysis.Critical Care.2022.https://ccforum.biomedcentral.com/articles/10.1186/s13054-022-03983-5

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time=2022-05-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1432319, encodeId=a3a1143231936, content=<a href='/topic/show?id=f9b9e9124a8' target=_blank style='color:#2F92EE;'>#综合征#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79124, encryptionId=f9b9e9124a8, topicName=综合征)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Sun May 22 08:48:15 CST 2022, time=2022-05-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1582296, encodeId=f31e158229638, content=<a href='/topic/show?id=e46f396832b' target=_blank style='color:#2F92EE;'>#呼吸窘迫#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, 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  5. 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time=2022-05-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1432319, encodeId=a3a1143231936, content=<a href='/topic/show?id=f9b9e9124a8' target=_blank style='color:#2F92EE;'>#综合征#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79124, encryptionId=f9b9e9124a8, topicName=综合征)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Sun May 22 08:48:15 CST 2022, time=2022-05-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1582296, encodeId=f31e158229638, content=<a href='/topic/show?id=e46f396832b' target=_blank style='color:#2F92EE;'>#呼吸窘迫#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=39683, encryptionId=e46f396832b, topicName=呼吸窘迫)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=22be16898890, createdName=12498cf9m40(暂无昵称), createdTime=Sun May 22 08:48:15 CST 2022, time=2022-05-22, status=1, ipAttribution=)]
    2023-02-17 drwjr
  6. 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time=2022-05-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1432319, encodeId=a3a1143231936, content=<a href='/topic/show?id=f9b9e9124a8' target=_blank style='color:#2F92EE;'>#综合征#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79124, encryptionId=f9b9e9124a8, topicName=综合征)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Sun May 22 08:48:15 CST 2022, time=2022-05-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1582296, encodeId=f31e158229638, content=<a href='/topic/show?id=e46f396832b' target=_blank style='color:#2F92EE;'>#呼吸窘迫#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=39683, encryptionId=e46f396832b, topicName=呼吸窘迫)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=22be16898890, createdName=12498cf9m40(暂无昵称), createdTime=Sun May 22 08:48:15 CST 2022, time=2022-05-22, status=1, ipAttribution=)]
    2022-05-22 西瓜0628

    学习了#学习#

    0

  7. 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