院内使用β受体阻滞剂的危重病人急性心力衰竭：是否和何时开始

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2025-04-01 DOI:10.1016/j.jclinane.2025.111824

Zeming Zhou MD , Haixu Wang MD , Wei Wang PhD , Jingkuo Li BM , Lubi Lei BM , Lihua Zhang MD, PhD , Haibo Zhang MD, PhD , Jiamin Liu MD, PhD , Xin Zheng MD, PhD

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引用次数: 0

摘要

背景：急性心力衰竭（AHF）住院期间β受体阻滞剂的使用仍然存在争议。本研究旨在探讨乙型受体阻滞剂的使用是否与AHF危重患者死亡风险降低相关，并确定启动乙型受体阻滞剂治疗的最佳时机。方法对MIMIC-IV 2.2版数据库中重症AHF患者的数据进行分析。收集入院时和住院期间的基线特征、实验室检查、合并症、生命体征和药物使用情况，以执行治疗加权逆概率（IPTW）。然后使用iptw加权逻辑回归模型来检验β受体阻滞剂使用与死亡率之间的关系。结果在iptw加权回归模型中，新开始使用受体阻滞剂或继续使用受体阻滞剂的患者与未接受受体阻滞剂治疗的患者相比，住院死亡风险较低(优势比[or]: 0.45；95%置信区间[CI]: 0.34 ~ 0.61, OR: 0.53；95% CI分别为0.41 ~ 0.69)。相反，停用受体阻滞剂的患者住院死亡率更高(OR: 2.59；95% CI: 1.63 - 4.10)。在β受体阻滞剂使用者中，与入院前接受治疗和入院后48小时内接受首次剂量的患者相比，入院前未接受治疗但48小时后开始治疗的患者死亡率风险相似(OR: 0.82；95% CI: 0.60 ~ 1.11；p = 0.202)。然而，先前接受β受体阻滞剂治疗的患者在48小时后开始治疗和入院前未接受治疗但在48小时内开始治疗的患者住院死亡率风险较低(OR: 0.44；95% CI: 0.30 ~ 0.64；P & lt;0.001, OR: 0.65；95% CI: 0.48 ~ 0.86；P = 0.003)。结论乙型受体阻滞剂在AHF住院期间的使用与住院死亡风险降低相关，停药与死亡风险增加相关。对于beta-blocker-naïve患者在48小时内启动β受体阻滞剂，对于入院前接受β受体阻滞剂治疗的患者在48小时后启动β受体阻滞剂可进一步降低死亡风险。

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In-hospital use of beta-blockers for critically ill patients with acute heart failure: Whether and when to initiate

Background

The use of beta-blockers during hospitalization for acute heart failure (AHF) remains controversial. This study aimed to investigate whether beta-blocker use is associated with a reduced risk of mortality in critically ill patients with AHF and to determine the optimal timing for initiating beta-blocker therapy.

Methods

Data from critically ill patients with AHF in the MIMIC-IV version 2.2 database were analyzed. Baseline characteristics, laboratory tests, comorbidities, vital signs, and medication usage at admission and during hospitalization were collected to perform inverse probability of treatment weighting (IPTW). IPTW-weighted logistic regression models were then used to examine the relationship between beta-blocker use and mortality.

Results

In the IPTW-weighted regression model, patients who newly started beta-blockers or continued their use had a lower risk of in-hospital mortality compared to those not treated with beta-blockers (odds ratio [OR]: 0.45; 95 % confidence interval [CI]: 0.34 to 0.61, and OR: 0.53; 95 % CI: 0.41 to 0.69, respectively). Conversely, those who had beta-blockers withdrawn showed a higher risk of in-hospital mortality (OR: 2.59; 95 % CI: 1.63 to 4.10). Among beta-blocker users, compared to patients treated before admission and who received their first dose within 48 h of admission, those who were not treated before admission but started after 48 h had a similar mortality risk (OR: 0.82; 95 % CI: 0.60 to 1.11; P = 0.202). However, patients previously treated with beta-blockers who initiated therapy after 48 h and those not treated before admission but started within 48 h had a lower risk of in-hospital mortality (OR: 0.44; 95 % CI: 0.30 to 0.64; P < 0.001, and OR: 0.65; 95 % CI: 0.48 to 0.86; P = 0.003, respectively).

Conclusion

The use of beta-blockers during hospitalization for AHF is associated with a reduced risk of in-hospital mortality, and withdrawal was associated with an increased risk of mortality. Initiating beta-blockers within 48 h for beta-blocker-naïve patients and after 48 h for those previously treated with beta-blockers before admission may further decrease mortality risk.

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.