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Received:April 22, 2024 Published Online:April 20, 2025
Received:April 22, 2024 Published Online:April 20, 2025
中文摘要: 目的 分析神经肌肉阻滞剂（NMBA）在ICU中机械通气患者中的应用安全性和有效性。方法 回顾性分析2015年至2022年期间入住德阳市人民医院ICU并接受机械通气的成年患者的数据。收集与分析患者的人口学特征、实验室数据、机械通气参数［呼吸末正压（PEEP）、平均气道压(Pmean)、气道峰值压力（Ppeak）］、动脉血气数据［pH、动脉氧分压（PaO2）、动脉二氧化碳分压（PaCO2）］、NMBAs使用情况、ICU住院时间及90 d的死亡率等。结果 共纳入2 765例机械通气患者，其中男性占55.23%，年龄为（69.89±14.66）岁，ICU住院期间90 d死亡率为30.78%(851/2 765)。与存活组相比，死亡组的年龄大，BMI低，序贯器官衰竭评分(SOFA)、急性生理学评分Ⅲ (APS Ⅲ)、全身炎性反应综合征(SIRS)评分、简化急性生理学评分Ⅱ (SAPS Ⅱ)、牛津急性疾病严重程度评分(OASIS) 更高（P<0.05），机械通气时间［137 (90, 237)h vs 75 (36, 143)h, Z=15.22, P<0.05］和ICU住院时间更长［7 (5, 12)d vs 5 (3, 10)d, Z=11.39, P<0.05］，并且更有可能接受超过48 h的NMBA治疗(4.23% vs 1.67%，P＜0.05)。在调整了年龄、性别和相关协变量后，发现NMBA使用时间超过48 h与死亡风险增加独立相关(调整后的HR＝2.48, 95%CI: 1.75~3.50)。亚组分析显示，在需要更高PEEP的患者中这种关联往往更强（HR＝2.90, 95%CI: 1.72~4.88）。结论 长期使用NMBA与需要机械通气的危重患者长期死亡风险增加有关。需要进一步的研究来验证该结果。
Abstract:Objective To analyze the safety and efficacy of neuromuscular blockers (NMBAs) in mechanically ventilated patients in the ICU. Methods A retrospective analysis was conducted on data from adult patients admitted to the ICU of Deyang People's Hospital and received mechanical ventilation from 2015 to 2022. Demographic characteristics, laboratory data, mechanical ventilation parameters ［positive end-expiratory pressure (PEEP), mean airway pressure (Pmean), peak airway pressure (Ppeak)］, arterial blood gas data ［pH, arterial oxygen partial pressure (PaO2), arterial carbon dioxide partial pressure (PaCO2)］, NMBA usage, length of ICU stay, and 90-day mortality were collected and analyzed. Results A total of 2 765 mechanically ventilated patients were included, of which 55.23% were male, aged (69.89±14.66) years, and the 90-day mortality rate during ICU stay was 30.78% (851/2765). Compared to the survivors, the mortality group had an older age, lower BMI, as well as higher sequential organ failure assessment (SOFA) score, acute physiological score (APS), systemic inflammatory response syndrome (SIRS) score, simplified acute physiology score Ⅱ (SAPS Ⅱ) score and Oxford acute severity of illness score (OASIS) (P＜0.05). In the mortality group, the duration of mechanical ventilation was longer ［137 (90, 237)h vs 75 (36, 143)h, Z=15.22, P<0.05］, and the length of ICU stay was longer ［7 (5, 12)d vs 5 (3, 10)d, Z=11.39, P<0.05］, and were also more likely to receive NMBA treatment for more than 48 hours (4.23% vs 1.67%, P＜0.05) compared to the survival group. After adjusting for age, sex, and relevant covariates, the use of NMBAs for more than 48 hours was found to be independently associated with increased mortality risk (adjusted HR=2.48, 95%CI: 1.75-3.50). Subgroup analysis showed that this association was stronger in patients requiring higher PEEP (HR=2.90, 95%CI: 1.72-4.88). Conclusion Long-term use of NMBA is associated with an increased long-term mortality risk in critically ill patients requiring mechanical ventilation. Further research is needed to validate these findings.
文章编号： 中图分类号：R563.8 文献标志码：A
基金项目:四川青年创新科研课题计划基金项目（Q20077）
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