重症监护病房的成年先天性心脏病患者

K. P. Ramlakhan, M. van der Bie, C. D. den Uil, E. Dubois, J. Roos‐Hesselink
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引用次数: 3

摘要

目的目前关于成人先天性心脏病(ACHD)患者重症监护病房(ICU)入院的数据有限,且主要集中在择期心脏手术后入院。本研究描述了非选择性ICU住院的ACHD患者。方法回顾性匹配队列研究于2000年1月至2015年12月在一家三级保健中心ICU(无心内科)进行。主要结局是短期(住院期间或出院后30天至随访结束)死亡率。结果比较非achd非选择性ICU入院患者,年龄、性别和入院诊断匹配1:1。结果在8.6年的随访中,共纳入138例入院的104例ACHD患者(男性65.9%,中位年龄30岁)。大多数人都有中度到重度的心脏缺陷。心律失常是最常见的入院诊断(44.2%),其次是出血(10.9%)、心力衰竭(8.7%)和肺部疾病(8.7%)。急性肾病入院患者的短期死亡率和总死亡率低于非急性肾病入院患者(4.8%对16.3%,p=0.005和17.3%对28.9%,p=0.030),而长期(12.5%对12.6%,p=0.700)无差异。基线时严重冠心病(HR 3.1, 95% CI 1.1至8.6)、ICU住院期间机械循环支持装置的使用(8.3,1.4至47.4)和紧急干预(0.2,0.1至0.7)与ACHD组的死亡率独立相关。结论非选择性住院的冠心病患者以心律失常和中重度冠心病患者居多。令人欣慰的是,与非ACHD患者相比,短期死亡率和总死亡率较低,然而,ACHD患者的长期死亡率高于预期。
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Adult patients with congenital heart disease in the intensive care unit
Objective Current data on intensive care unit (ICU) admissions in patients with adult congenital heart disease (ACHD) are limited and focus on admissions after elective cardiac surgery. This study describes non-elective ICU admissions in patients with ACHD. Methods A retrospective matched cohort study was performed from January 2000 until December 2015 in a tertiary care centre ICU (there was no cardiac care unit). Primary outcomes were short-term (during hospital stay or <30 days after discharge) and long-term (>30 days after discharge until end of follow-up) mortality. Outcomes were compared with non-ACHD non-elective ICU admissions, matched 1:1 on age, sex and admission diagnosis. Results A total of 138 admissions in 104 patients with ACHD (65.9% male, median age 30 years) were included, during 8.6 years of follow-up. The majority had a moderate-to-severe heart defect. Arrhythmia was the most common admission diagnosis (44.2%), followed by haemorrhage (10.9%), heart failure (8.7%) and pulmonary disease (8.7%). Short-term mortality and total mortality were lower in the ACHD admissions than in the non-ACHD admissions (4.8% vs 16.3%, p=0.005 and 17.3% vs 28.9%, p=0.030), whereas long-term (12.5% vs 12.6%, p=0.700) did not differ. Severe CHD (HR 3.1, 95% CI 1.1 to 8.6) at baseline, and mechanical circulatory support device use (8.3, 1.4 to 47.4) and emergency intervention (0.2, 0.1 to 0.7) during the ICU stay were independently associated with mortality in the ACHD group. Conclusions Non-elective ICU admissions in patients with ACHD are most often for arrhythmia and in patients with moderate-to-severe CHD. Reassuringly, short-term and total mortality are lower compared with patients without ACHD, however, long-term mortality is higher than expected for patients with ACHD.
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