先天性心脏病患者心血管磁共振检查期间不良事件的危险因素。

Risk factors for adverse events during cardiovascular magnetic resonance in congenital heart disease.

作者信息

Dorfman Adam L, Odegard Kirsten C, Powell Andrew J, Laussen Peter C, Geva Tal

机构信息

Department of Cardiology, Children's Hospital Boston and Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA.

出版信息

J Cardiovasc Magn Reson. 2007;9(5):793-8. doi: 10.1080/10976640701545305.

DOI:10.1080/10976640701545305

PMID:17891617

Abstract

PURPOSE

To assess the incidence and severity of adverse events (AE) associated with cardiovascular magnetic resonance (CMR) in a large cohort of patients with congenital heart disease and to identify independent risk factors for their occurrence.

METHODS

AEs were prospectively recorded from October 2002 through December 2004 and graded by 3 independent observers for severity, preventability, and attributability. The rate of adverse events was analyzed for each candidate variable using Fisher's exact test and independent predictors were identified by multiple logistic regression analysis.

RESULTS

There were 22 AEs among 1334 CMR studies (1.6%); 14 (63.5%) minor, 7 (32%) moderate, and 1 (4.5%) major. General anesthesia (GA) was used in 274 studies (20.5%) with 12 AEs (4.4%, p<0.001). There were 7 AEs (6.3%, p=0.001) in 112 studies on hospitalized patients, 5 AEs (5.2%, p=0.018) in 97 patients under 1 year of age, and 3 AEs (2.2%, p=0.479) in 134 patients with functional single ventricle. The highest rate of AEs was noted in inpatients under GA (10.4%, p<0.001); most were in the intensive care unit. Use of anesthesia (OR 3.91 [95% CI 1.46, 10.48] p=0.007) and inpatient status (OR 3.56 [95% CI 1.16, 10.89], p=0.026) were independent predictors of AEs.

CONCLUSIONS

CMR in patients with congenital heart disease has a low rate of AEs. Use of GA and examinations on hospitalized patients are independent risk factors for AEs with the most acutely ill patients at highest risk.

摘要

目的

评估一大群先天性心脏病患者中与心血管磁共振成像（CMR）相关的不良事件（AE）的发生率和严重程度，并确定其发生的独立危险因素。

方法

从2002年10月至2004年12月前瞻性记录不良事件，并由3名独立观察者对严重程度、可预防性和可归因性进行分级。使用Fisher精确检验分析每个候选变量的不良事件发生率，并通过多元逻辑回归分析确定独立预测因素。

结果

1334例CMR研究中有22例不良事件（1.6%）；14例（63.5%）为轻度，7例（32%）为中度，1例（4.5%）为重度。274例研究（20.5%）使用了全身麻醉（GA），其中有12例不良事件（4.4%，p<0.001）。112例住院患者的研究中有7例不良事件（6.3%，p=0.001），97例1岁以下患者中有5例不良事件（5.2%，p=0.018），134例功能性单心室患者中有3例不良事件（2.2%，p=0.479）。全身麻醉下的住院患者不良事件发生率最高（10.4%，p<0.001）；大多数发生在重症监护病房。使用麻醉（比值比3.91[95%可信区间1.46，10.48]，p=0.007）和住院状态（比值比3.56[95%可信区间1.16，10.89]，p=0.026）是不良事件的独立预测因素。