Liu Chung-Pin, Ho Yi-Lwun, Lin Yen-Hung, Liu Yen-Bin, Chang Wei-Tien, Huang Chien-Hua, Chen Wen-Jone
Department of Internal Medicine (Division of Cardiology), Yuan's General Hospital, Kaohsiung, Taiwan.
Emerg Med J. 2007 Feb;24(2):106-9. doi: 10.1136/emj.2006.037788.
With rapid improvements in technology and accumulation of clinical evidence, the implantable cardioverter defibrillator (ICD) has become a standard treatment for either primary or secondary prevention of sudden cardiac death. However, no analysis based on the perspective of emergency department has been reported, and managing patients with ICD remains a challenge to the emergency department doctors.
This study reviewed the emergency department visits of patients who received ICD implantation in a single university hospital from 1995 to 2004. The baseline demographic and laboratory data were compared between groups with the non-parametric method of the Mann-Whitney U test for continuous data and the chi2 test for categorical data; p<0.05 was considered significant.
81 patients (56 men and 25 women) were included in this study. 43% of patients had at least one emergency department visit during the follow-up period, and a total of 86 emergency department visits were recorded. The most frequent aetiology of emergency department visits was ICD discharge (37 episodes; 43.1%) and the most frequent presenting symptom was electric shock sensation (25 episodes; 29.1%). Only 11 (12.8%) emergency department visits were because of non-cardiac aetiologies. Patients with emergency department visits had significant lower left ventricular ejection fraction (mean (SD) 41.5 (19.8) v 55.2 (18.4) ejection fraction units; p = 0.005) and more use of warfarin (8.6% v 0%; p<0.05). Although most emergency department visits were device or arrhythmia related, the acute coronary syndrome and congestive heart failure still accounted for 27.9% of hospital returns in combination.
Defibrillator discharge, acute coronary syndrome and heart failure constitute most aetiologies of emergency department visits of patients with ICD. The risk factors include lower left ventricular ejection fraction and use of warfarin.
随着技术的快速进步和临床证据的积累，植入式心脏复律除颤器（ICD）已成为心脏性猝死一级或二级预防的标准治疗方法。然而，尚未有基于急诊科视角的分析报道，且对植入ICD患者的管理对急诊科医生而言仍是一项挑战。
本研究回顾了1995年至2004年在一所大学医院接受ICD植入的患者的急诊科就诊情况。采用非参数检验的Mann-Whitney U检验对连续数据进行组间基线人口统计学和实验室数据比较，采用卡方检验对分类数据进行比较；p<0.05被认为具有统计学意义。
本研究纳入81例患者（56例男性和25例女性）。43%的患者在随访期间至少有一次急诊科就诊，共记录到86次急诊科就诊。急诊科就诊最常见的病因是ICD放电（37次发作；43.1%），最常见的症状是电击感（25次发作；29.1%）。仅有11次（12.8%）急诊科就诊是由非心脏病因引起。有急诊科就诊的患者左心室射血分数显著更低（平均（标准差）41.5（19.8）对55.2（18.4）射血分数单位；p = 0.005），且华法林使用更多（8.6%对0%；p<0.05）。尽管大多数急诊科就诊与设备或心律失常相关，但急性冠状动脉综合征和充血性心力衰竭仍合计占住院再入院的27.9%。
除颤器放电、急性冠状动脉综合征和心力衰竭构成ICD患者急诊科就诊的大多数病因。危险因素包括较低的左心室射血分数和华法林的使用。
Zotero 插件