先天性心脏病手术期间的 α 阻断：国家数据库分析。
Alpha-blockade during congenital heart surgery admissions: analysis from national database.
机构信息
Cardiology, Advocate Children's Hospital, Chicago, IL, USA.
Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, México.
出版信息
Cardiol Young. 2022 Jul;32(7):1136-1142. doi: 10.1017/S1047951121003875. Epub 2021 Sep 17.
INTRODUCTION
The effects of alpha-blockade on haemodynamics during and following congenital heart surgery are well documented, but data on patient outcomes, mortality, and hospital charges are limited. The purpose of this study was to characterise the use of alpha-blockade during congenital heart surgery admissions and to determine its association with common clinical outcomes.
MATERIALS AND METHODS
A cross-sectional study was conducted using the Pediatric Health Information System database. De-identified data for patients under 18 years of age with a cardiac diagnosis who underwent congenital heart surgery were obtained from 2004 to 2015. Patients were subdivided on the basis of receiving alpha-blockade with either phenoxybenzamine or phentolamine during admission or not. Continuous and categorical variables were analysed using Mann−Whitney U-tests and Fisher exact tests, respectively. Characteristics between subgroups were compared using univariate analysis. Regression analyses were conducted to determine the impact of alpha-blockade on ICU length of stay, hospital length of stay, billed charges, and mortality.
RESULTS
Of the 81,313 admissions, 4309 (5.3%) utilised alpha-blockade. Phentolamine was utilised in 4290 admissions. In univariate analysis, ICU length of stay, total length of stay, inpatient mortality, and billed charges were all significantly higher in the alpha-blockade admissions. However, regression analyses demonstrated that other factors were behind these increased. Alpha-blockade was significantly, independently associated with a 1.5 days reduction in ICU length of stay (p < 0.01) and a 3.5 days reduction in total length of stay (p < 0.01). Alpha-blockade was significantly, independently associated with a reduction in mortality (odds ratio 0.8, 95% confidence interval 0.7−0.9). Alpha-blockade was not independently associated with any significant change in billed charges.
CONCLUSIONS
Alpha-blockade is used in a subset of paediatric cardiac surgeries and is independently associated with significant reductions in ICU length of stay, hospital length of stay, and mortality without significantly altering billed charges.
引言
α-阻滞剂在先天性心脏病手术期间和之后对血液动力学的影响已有充分的记录，但关于患者结局、死亡率和住院费用的数据有限。本研究的目的是描述在先天性心脏病手术入院期间使用α-阻滞剂的情况，并确定其与常见临床结局的关系。
材料和方法
使用儿科健康信息系统数据库进行了一项横断面研究。从 2004 年至 2015 年，获得了年龄在 18 岁以下、有心脏诊断并接受过先天性心脏病手术的患者的匿名数据。根据患者在入院期间是否接受过酚苄明或苯肾上腺素的α-阻滞剂治疗，将患者分为两组。连续变量和分类变量分别采用 Mann-Whitney U 检验和 Fisher 确切检验进行分析。使用单变量分析比较亚组之间的特征。进行回归分析以确定 α-阻滞剂对 ICU 住院时间、住院时间、计费费用和死亡率的影响。
结果
在 81313 例入院中，有 4309 例（5.3%）使用了α-阻滞剂。在 4290 例入院中使用了苯肾上腺素。在单变量分析中，ICU 住院时间、总住院时间、住院死亡率和计费费用在使用α-阻滞剂的入院中均显著升高。然而，回归分析表明，其他因素导致了这些增加。α-阻滞剂与 ICU 住院时间减少 1.5 天（p < 0.01）和总住院时间减少 3.5 天（p < 0.01）显著相关。α-阻滞剂与死亡率降低显著相关（比值比 0.8，95%置信区间 0.7-0.9）。α-阻滞剂与计费费用的任何显著变化均无显著相关性。
结论
α-阻滞剂在小儿心脏手术的一部分中使用，并与 ICU 住院时间、住院时间和死亡率的显著降低独立相关，而不会显著改变计费费用。
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