{"title":"右美托咪定与手术后蛛网膜下腔出血患者住院死亡风险降低相关","authors":"Ying Liu, Jiao Peng, Yuan-Hui Zhang, Hai-Tao Liu","doi":"10.1016/j.wneu.2024.11.122","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Subarachnoid hemorrhage (SAH) is a severe neurologic event with high mortality. The choice of sedatives in SAH management may influence patient outcomes. This study aimed to investigate the association between sedatives and in-hospital mortality among patients with SAH.</p><p><strong>Methods: </strong>This study analyzed data from the MIMIC-IV database, and in-hospital mortality was the primary outcome. Key variables collected included sedatives, demographics, comorbidities, vital signs, laboratory tests, and severity scores. Univariate and multivariate logistic regression analyses were used to assess associations between sedative use and in-hospital mortality, with adjustments for confounding factors. Further stratified analyses explored the effects of dexmedetomidine across different patient subgroups, and mediation analysis evaluated the role of creatinine in the relationship between dexmedetomidine and mortality.</p><p><strong>Results: </strong>A total of 527 patients were included in this study, with 301 males. Compared with propofol and midazolam, the use of dexmedetomidine was significantly related to the reduction of in-hospital mortality in patients with SAH (odds ratio, 0.369; 95% confidence interval, 0.237-0.574; P < 0.001). After adjusting for variables such as demographics, comorbidities, and laboratory tests, dexmedetomidine remained associated with lower in-hospital mortality. In addition, our findings indicated that dexmedetomidine use was associated with a reduced risk of in-hospital mortality regardless of the presence of cerebrovascular disease. We discovered that creatinine acted as a mediator in the protective effect of dexmedetomidine on in-hospital mortality.</p><p><strong>Conclusions: </strong>Dexmedetomidine is associated with significantly lower in-hospital mortality in patients with SAH. These findings underscore the importance of sedative choice for patients with SAH, suggesting that dexmedetomidine could enhance patient outcomes.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"123539"},"PeriodicalIF":1.9000,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Dexmedetomidine is Associated with Reduced In-Hospital Mortality Risk of Patients with Subarachnoid Hemorrhage Undergoing Surgery.\",\"authors\":\"Ying Liu, Jiao Peng, Yuan-Hui Zhang, Hai-Tao Liu\",\"doi\":\"10.1016/j.wneu.2024.11.122\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Subarachnoid hemorrhage (SAH) is a severe neurologic event with high mortality. The choice of sedatives in SAH management may influence patient outcomes. This study aimed to investigate the association between sedatives and in-hospital mortality among patients with SAH.</p><p><strong>Methods: </strong>This study analyzed data from the MIMIC-IV database, and in-hospital mortality was the primary outcome. Key variables collected included sedatives, demographics, comorbidities, vital signs, laboratory tests, and severity scores. Univariate and multivariate logistic regression analyses were used to assess associations between sedative use and in-hospital mortality, with adjustments for confounding factors. Further stratified analyses explored the effects of dexmedetomidine across different patient subgroups, and mediation analysis evaluated the role of creatinine in the relationship between dexmedetomidine and mortality.</p><p><strong>Results: </strong>A total of 527 patients were included in this study, with 301 males. Compared with propofol and midazolam, the use of dexmedetomidine was significantly related to the reduction of in-hospital mortality in patients with SAH (odds ratio, 0.369; 95% confidence interval, 0.237-0.574; P < 0.001). After adjusting for variables such as demographics, comorbidities, and laboratory tests, dexmedetomidine remained associated with lower in-hospital mortality. In addition, our findings indicated that dexmedetomidine use was associated with a reduced risk of in-hospital mortality regardless of the presence of cerebrovascular disease. We discovered that creatinine acted as a mediator in the protective effect of dexmedetomidine on in-hospital mortality.</p><p><strong>Conclusions: </strong>Dexmedetomidine is associated with significantly lower in-hospital mortality in patients with SAH. These findings underscore the importance of sedative choice for patients with SAH, suggesting that dexmedetomidine could enhance patient outcomes.</p>\",\"PeriodicalId\":23906,\"journal\":{\"name\":\"World neurosurgery\",\"volume\":\" \",\"pages\":\"123539\"},\"PeriodicalIF\":1.9000,\"publicationDate\":\"2025-02-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"World neurosurgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.wneu.2024.11.122\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/12/23 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q3\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"World neurosurgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.wneu.2024.11.122","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/12/23 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景：蛛网膜下腔出血（SAH）是一种严重的神经系统事件，死亡率高。镇静剂在SAH治疗中的选择可能会影响患者的预后。本研究旨在探讨镇静药与SAH患者住院死亡率之间的关系。方法：本研究分析来自MIMIC-IV数据库的数据，以住院死亡率为主要结局。收集的关键变量包括镇静剂、人口统计学、合并症、生命体征、实验室检查和严重程度评分。采用单因素和多因素logistic回归分析评估镇静剂使用与住院死亡率之间的关系，并对混杂因素进行调整。进一步的分层分析探讨了右美托咪定对不同患者亚组的影响，并通过中介分析评估了肌酐在右美托咪定与死亡率之间的关系中的作用。结果：本研究共纳入527例患者，其中男性301例。与异丙酚和咪达唑仑相比，右美托咪定的使用与SAH患者住院死亡率的降低显著相关（OR = 0.369, 95% CI: 0.237-0.574, p < 0.001）。在调整了人口统计学、合并症和实验室检查等变量后，右美托咪定仍与较低的住院死亡率相关。此外，我们的研究结果表明，无论是否存在脑血管疾病，右美托咪定的使用都与院内死亡风险降低相关。重要的是，我们发现肌酐在右美托咪定对住院死亡率的保护作用中起中介作用。结论：右美托咪定可显著降低SAH患者的住院死亡率。这些发现强调了镇静选择对SAH患者的重要性，表明右美托咪定可以提高患者的预后。
Dexmedetomidine is Associated with Reduced In-Hospital Mortality Risk of Patients with Subarachnoid Hemorrhage Undergoing Surgery.
Background: Subarachnoid hemorrhage (SAH) is a severe neurologic event with high mortality. The choice of sedatives in SAH management may influence patient outcomes. This study aimed to investigate the association between sedatives and in-hospital mortality among patients with SAH.
Methods: This study analyzed data from the MIMIC-IV database, and in-hospital mortality was the primary outcome. Key variables collected included sedatives, demographics, comorbidities, vital signs, laboratory tests, and severity scores. Univariate and multivariate logistic regression analyses were used to assess associations between sedative use and in-hospital mortality, with adjustments for confounding factors. Further stratified analyses explored the effects of dexmedetomidine across different patient subgroups, and mediation analysis evaluated the role of creatinine in the relationship between dexmedetomidine and mortality.
Results: A total of 527 patients were included in this study, with 301 males. Compared with propofol and midazolam, the use of dexmedetomidine was significantly related to the reduction of in-hospital mortality in patients with SAH (odds ratio, 0.369; 95% confidence interval, 0.237-0.574; P < 0.001). After adjusting for variables such as demographics, comorbidities, and laboratory tests, dexmedetomidine remained associated with lower in-hospital mortality. In addition, our findings indicated that dexmedetomidine use was associated with a reduced risk of in-hospital mortality regardless of the presence of cerebrovascular disease. We discovered that creatinine acted as a mediator in the protective effect of dexmedetomidine on in-hospital mortality.
Conclusions: Dexmedetomidine is associated with significantly lower in-hospital mortality in patients with SAH. These findings underscore the importance of sedative choice for patients with SAH, suggesting that dexmedetomidine could enhance patient outcomes.
期刊介绍：
World Neurosurgery has an open access mirror journal World Neurosurgery: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review.
The journal''s mission is to:
-To provide a first-class international forum and a 2-way conduit for dialogue that is relevant to neurosurgeons and providers who care for neurosurgery patients. The categories of the exchanged information include clinical and basic science, as well as global information that provide social, political, educational, economic, cultural or societal insights and knowledge that are of significance and relevance to worldwide neurosurgery patient care.
-To act as a primary intellectual catalyst for the stimulation of creativity, the creation of new knowledge, and the enhancement of quality neurosurgical care worldwide.
-To provide a forum for communication that enriches the lives of all neurosurgeons and their colleagues; and, in so doing, enriches the lives of their patients.
Topics to be addressed in World Neurosurgery include: EDUCATION, ECONOMICS, RESEARCH, POLITICS, HISTORY, CULTURE, CLINICAL SCIENCE, LABORATORY SCIENCE, TECHNOLOGY, OPERATIVE TECHNIQUES, CLINICAL IMAGES, VIDEOS
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