【原】【罌粟摘要】苯二氮卓類術(shù)前用藥與患者30天死亡率的相關(guān)性：老年人介入治療結(jié)果研究的傾向評分加權(quán)分析（POSE）

罌粟花anesthGH 2022-09-29 發(fā)布于貴州

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苯二氮卓類術(shù)前用藥與患者30天死亡率的相關(guān)性
老年人介入治療結(jié)果研究的傾向評分加權(quán)分析（POSE）

貴州醫(yī)科大學(xué) 麻醉與心臟電生理課題組
翻譯：文春雷編輯：潘志軍審校：曹瑩

背景：最近指南建議老年患者應(yīng)避免使用苯二氮卓類藥物，但支持證據(jù)有限。

目的：我們對POSE數(shù)據(jù)進行二次分析，探討80歲以上患者術(shù)前使用苯二氮卓類藥物與其30天死亡率的相關(guān)性。

設(shè)計：我們使用傾向評分方法對術(shù)前使用苯二氮卓類藥物與患者30天死亡率的相關(guān)性的POSE研究進行混雜因素調(diào)整的事件-時間分析。

地點：POSE是一項歐洲多中心前瞻性隊列研究。

患者：80歲以上患者在麻醉下進行或不進行手術(shù)。

結(jié)果：共分析了9497例患者。1521例患者術(shù)前使用苯二氮卓類藥物，7936例患者未接受苯二氮卓類藥物治療，30例接受可樂定治療，10例缺少術(shù)前用藥數(shù)據(jù)。反向傾向評分加權(quán)對數(shù)秩分析沒有提供明確的證據(jù)表明苯二氮卓類藥物與30天死亡率有相關(guān)性；中位數(shù)[范圍]P?=?0.048[0.044-0.078]，評估苯二氮卓類藥物術(shù)前用藥和非苯二氮卓類藥物術(shù)前用藥患者的30天死亡率分別為3.21%和4.45%。反向傾向評分加權(quán)Cox回歸得出風(fēng)險比為0.71（95%CI 0.49-1.04），表明苯二氮卓類藥物治療組的30天死亡率可能降低。使用敏感性分析，包括亞組、配對和亞分類分析，也得到了相似的結(jié)果。

結(jié)論：對POSE數(shù)據(jù)的二次分析未發(fā)現(xiàn)苯二氮卓類術(shù)前用藥與30天死亡率之間明確關(guān)聯(lián)的證據(jù)。評估表明術(shù)前應(yīng)用苯二氮卓類藥物的患者30天死亡率降低。我們提出的結(jié)果可能受到未測量的混雜因素的影響，這可以在一個隨機試驗中得到解決。

原始文獻來源：Ana KowarkM, Moritz BergerM, Rolf Rossaint, et al. Association between benzodiazepine premedication and 30-day mortality rate A propensity-score weighted analysis of the Peri-interventional Outcome Study in the Elderly (POSE).[J]. Eur J Anaesthesiol 2022; 39 :210–218.

英文原文

Association between benzodiazepine premedication and 30-day mortality rate

A propensity-score weighted analysis of the Peri-interventional Outcome Study in the Elderly (POSE)

DBACKGROUND：Recent guidelines suggest that benzodiazepine premedication should be avoided in elderly patients,though with limited supporting evidence.

OBJECTIVE：We conducted a secondary analysis of the POSE data to explore the association of premedication in patients aged 80 years or older with 30-day mortality.

DESIGN：We used propensity score methods to perform a confounder-adjusted time-to-event analysis of the association between benzodiazepine premedication and 30-day mortality of the POSE study.

SETTING POSE：was conducted as a European multicentre prospective cohort study.

PATIENTS：Adults aged 80 years or older scheduled for surgical or nonsurgical intervention under anaesthesia.

RESULTS：A total of 9497 patients were analysed. One thousand five hundred and twenty-one patients received benzodiazepine premedication, 7936 patients received no benzodiazepine premedication, 30 received clonidine and 10 had missing premedication data. Inverse propensityscore-weighted log-rank analysis did not provide unambiguous evidence for an association between benzodiazepine premedication and 30-day mortality; median [range] P=0.048 [0.044 to 0.078], estimated 30-day mortality rates 3.21% and 4.45% in benzodiazepine-premedicated and nonbenzodiazepine-premedicated patients, respectively.Inverse propensity-score-weighted Cox regression resulted in a hazard ratio of 0.71 (95% CI 0.49 to 1.04), pointing at a possible reduction of 30-day mortality in the benzodiazepine premedication group. Sensitivity analyses, which constituted subgroup, matched-pairs, and subclassification analyses,resulted in similar findings.

CONCLUSION：This secondary analysis of the POSE data did not find evidence for an unambiguous association between benzodiazepine premedication and 30-day mortality. Point estimates indicated a reduction of 30-day mortality in benzodiazepine-premedicated patients. The results presented here might be affected by unmeasured confounding factors, which could be addressed in a randomised trial.