Anesthesiology：依托咪酯对心脏手术患者预后有影响吗？

南粤麻医

http://www.ncbi.nlm.nih.gov/pubmed/24296761

Anesthesiology. 2014 Mar;120(3):579-89. doi: 10.1097/ALN.0000000000000087.

Etomidate Use and Postoperative Outcomes among Cardiac Surgery Patients.

Wagner CE1, Bick JS, Johnson D, Ahmad R, Han X, Ehrenfeld JM, Schildcrout JS, Pretorius M.

Abstract

BACKGROUND:

Although a single dose of etomidate can cause relative adrenal insufficiency, the impact of etomidate exposure on postoperative outcomes is unknown. The objective of this study was to examine the association between a single induction dose of etomidate and clinically important postoperative outcomes after cardiac surgery.

METHODS:

The authors retrospectively examined the association between etomidate exposure during induction of anesthesia and postoperative outcomes in patients undergoing cardiac surgery from January 2007 to December 2009 by using multivariate logistic regression analyses and Cox proportional hazards regression analyses. Postoperative outcomes of interest were severe hypotension, mechanical ventilation hours, hospital length of stay, and in-hospital mortality.

RESULTS:

Sixty-two percent of 3,127 patients received etomidate. Etomidate recipients had a higher incidence of preoperative congestive heart failure (23.0 vs. 18.3%; P = 0.002) and a lower incidence of preoperative cardiogenic shock (1.3 vs. 4.0%; P < 0.001). The adjusted odds ratio for severe hypotension and in-hospital mortality associated with receiving etomidate was 0.80 (95% CI, 0.58-1.09) and 0.75 (95% CI, 0.45-1.24), respectively, and the adjusted hazard ratio for time to mechanical ventilation removal and time to hospital discharge was 1.10 (95% CI, 1.00-1.21) and 1.07 (95% CI, 0.97-1.18), respectively. Propensity score analysis did not change the association between etomidate use and postoperative outcomes.

CONCLUSIONS:

In this study, there was no evidence to suggest that etomidate exposure was associated with severe hypotension, longer mechanical ventilation hours, longer length of hospital stay, or in-hospital mortality. Etomidate should remain an option for induction of anesthesia in cardiac surgery patients.

PMID: 24296761

南粤麻医

该研究回顾性分析了Vanderbilt大学医院3年间的3127例心脏手术患者，其中62%诱导时单次注射依托咪酯。

结果发现，使用依托咪酯与否对心脏手术后的严重低血压及死亡率发生率并无统计学影响；术后机械通气及出院时间也无统计学差异。

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南粤麻医

去除混在因素的影响之后，作者得出结论认为，尚无证据表明单次注射依托咪酯与严重低血压、机械通气时间、住院时间或院内死亡率增高有关。术后严重低血压是机械通气时间延长、住院时间延长及死亡率增高的独立危险因素。

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南粤麻医

依托咪酯单次使用影响肾上腺皮质功能基本明确，但是否产生临床意义尚值得商榷。目前研究结果也存在争议。虽然部分回顾性分析认为依托咪酯可增加死亡率，但没有一项前瞻性研究支持这一结果。

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南粤麻医

术前心室功能不佳及存在明显合并症的心脏患者，麻醉医生可能更倾向于选择依托咪酯。因此这类患者可能更容易发生依托咪酯诱发肾上腺皮质功能相对不足引起的不良结果。但是，本回顾性研究分析中依托咪酯组充血性心衰的患者比例明显高于非依托咪酯组，即便如此，作者并未发现依托咪酯的使用与住院死亡率增加有关。

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