β1－受体阻滞剂对急性脑卒中患者感染和死亡风险的影响  

Effect of β - blocker therapy on the risk of infections and death after acute stroke

作　　者：张玉国[1] 孙巧[2] 王界成[2] 李玉华[2] 

机构地区：[1]青海省中医院医保科,青海西宁810000 [2]青海省中医院脑病科,青海西宁810000

出　　处：《中国急救医学》2015年第9期823-826,共4页Chinese Journal of Critical Care Medicine

摘　　要：目的：探讨β1－受体阻滞剂治疗脑卒中后对患者感染和死亡率的影响。方法本研究是前瞻性队列研究，将2012－01～2014－06在我院神经内科接受治疗的125例急性脑卒中患者纳入研究，根据患者是否服用β1－受体阻滞剂将患者分为β1－受体阻滞剂组60例（治疗组）与无β1－受体阻滞剂组65例（对照组），使用流式细胞仪检测患者iNKT细胞值，利用多变量Poisson过程和Cox回归模型分析β1－受体阻滞剂治疗对脑卒中后肺炎、尿路感染和死亡率的影响。结果110例（88．3％）患者是缺血性脑卒中，15例（11．7％）患者是出血性脑卒中。神经功能缺损评分（NIHSS）基线值为8分（5～16分）。60例（48．2％）患者接受β1－受体阻滞剂治疗。β1－受体阻滞剂治疗对脑卒中后患者肺炎的发生没有影响，差异无统计学意义（ RR＝1．00，95％CI 0．77～1．30，P＝0.995）。而β1－受体阻滞剂治疗患者尿路感染的风险明显降低（RR＝0．65，95％CI 0．43～0.98，P＝0．040）。7 d死亡率差异无统计学意义（RR＝1．36，95％CI 0．65～2．77， P＝0．425），而β1－受体阻滞剂治疗患者30 d死亡率较高（ HR＝1．93，95％ CI 1．20～3．10， P＝0.006）。治疗组肺炎患者亚组与尿路感染亚组患者iNKT细胞值的组内差异无统计学意义，组间比较尿路感染亚组的iNKT细胞较低（P＜0．05）。结论β1－受体阻滞剂治疗不能减少患者卒中后发生肺炎的危险，但能显著降低尿路感染的风险。Objective To investigate the effect of β1 - blocker therapy on the risk of infections and death after stroke in human. Methods A total of 125 patients with ischemic or hemorrhagic stroke, admitted to our hospital stroke unit from 2012 January to 2014 June, were included in this historical cohort study. Subjects were divided into β1 - blocker group （ therapy group） and no - β1 - Blocker （control group）, iNKT value was detected in patients by flow cytometry. The effect of β1 -blocker therapy on post - stroke pneumonia, urinary tract infections and death was investigated using muhivariable Poisson and Cox regression models. Results One hundred and ten （88.3%） patients were admitted with ischemic stroke, the remaining 15 （ 11.7% ） patients had a hemorrhagic stroke. Median baseline NIHSS was 8 （ 5 ~ 16 ） points. Sixty （48. 2% ） patients received beta - blocker therapy. There was no difference in the risk of post - stroke pneumonia between patients with and without [31 -blocker therapy （RR = 1.00, 95% CI 0.77 ~ 1.30, P =0. 995）. Patients with 61 - blocker therapy showed a decreased risk for urinary tract infections （ RR = 0.65, 95% CI 0. 43 ~ 0.98, P = 0. 040）. 7 - days mortality did not differ between groups （ HR = 1.36, 95% CI 0. 65 ~ 2.77, P = 0. 425 ）, while patients with β1 - blocker therapy showed a higher 30 - days mortality （ HR = 1.93, 95% CI 1.20 ~3.10, P =0. 006）. There was no significant difference in iNKT values between the patients with pneumonia and urinary tract infection, and the iNKT value in the urinary tract infection group was significantly lower than the pneumonia group （P 〈 0.05 ）. Conclusion βl - blocker therapy does not reduce the risk for post - stroke pneumonia, hut significantly reduces the risk for urinary tract infections.

关 键 词：Β1-受体阻滞剂 脑卒中 尿路感染 肺炎 死亡 

分 类 号：R972[医药卫生—药品]