介入放射学患者心脏骤停和医疗紧急情况相关的风险因素及合并症。
Risk factors and comorbidities associated with cardiac arrests and medical emergencies in interventional radiology patients.
作者信息
AlHarbi Husam Mohammed, Arabi Tarek, Alduribi Yasser Saleh A, Shah Hassan, Sabbah Ahmad, Othman Khalid, Bashir Omar, Arabi Mohammad
机构信息
Division of Vascular and Interventional Radiology, Department of Medical Imaging, King Abdulaziz Medical City-Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.
College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
出版信息
CVIR Endovasc. 2024 Dec 18;7(1):89. doi: 10.1186/s42155-024-00504-z.
PURPOSE
To investigate the incidence, predictors, and outcomes of medical emergencies in patients undergoing IR procedures at a tertiary care center.
MATERIALS AND METHODS
Seven-year retrospective review of all medical emergencies in patients undergoing IR procedures at King Abdulaziz Medical City, Riyadh, Saudi Arabia. Medical emergencies included Cardiopulmonary arrest (CPA), or emergencies that required activation of the critical care response team (CCRT). Variables included demographics, procedure details and outcome data including complications and 30-day mortality. Multivariate logistic regression analysis was conducted to identify independent predictors of CPA and 30-day mortality.
RESULTS
Ninety-four patients (50% male) were included with a median age of 60.5 years. Recent or current ICU admission was recorded in 39 patients (43.8%). Comorbidities included diabetes (50%), hypertension (59.6%), coronary artery disease (25.5%), heart failure (21.5%), ESRD (28.7%), active infection 28 (31%), with ASA3 in 64 patients (68%) and ASA4 in 23 (24.5%). The incidence of CPA and CCRT activation was 0.045% and 0.049%, respectively, among 100,000 patients who underwent IR procedures during the study period. Half the events were with venous procedures, followed by non-vascular (33%) and arterial procedures (10.6%). 30-day mortality was 30.5%. Independent predictors of CPA included pulmonary disease (aOR 16.79, 95% CI 2.334-195.3, p = 0.0097), emergency procedures (aOR 11.63, 95% CI 2.517-72.46, p = 0.0035), general anesthesia (aOR 19.41, 95% CI 1.854-491.8, p = 0.0254), and sedation (aOR 13.04, 95% CI 2.081-118.8, p = 0.0108). Predictors of 30-day mortality were CPA (aOR 9.830, 95% CI 2.439-66.66, p = 0.0045) and hypotension as a complication (aOR 16.81, 95% CI 3.766-122.3, p = 0.0009).
CONCLUSION
Our findings highlight the complexity of patients undergoing IR procedures and the importance of identifying high-risk patients to prevent adverse events in the IR setting.
目的
调查在一家三级医疗中心接受介入放射学（IR）手术的患者中医疗紧急情况的发生率、预测因素及结果。
材料与方法
对沙特阿拉伯利雅得阿卜杜勒阿齐兹国王医疗城接受IR手术患者的所有医疗紧急情况进行为期七年的回顾性研究。医疗紧急情况包括心肺骤停（CPA）或需要启动重症监护反应小组（CCRT）的紧急情况。变量包括人口统计学、手术细节及结果数据，包括并发症和30天死亡率。进行多因素逻辑回归分析以确定CPA和30天死亡率的独立预测因素。
结果
纳入94例患者（50%为男性），中位年龄60.5岁。39例患者（43.8%）有近期或当前入住重症监护病房记录。合并症包括糖尿病（50%）、高血压（59.6%）、冠状动脉疾病（25.5%）、心力衰竭（21.5%）、终末期肾病（28.7%）、活动性感染28例（31%），64例患者（68%）为ASA3级，23例（24.5%）为ASA4级。在研究期间接受IR手术的100,000例患者中，CPA和CCRT启动的发生率分别为0.045%和0.049%。一半的事件发生在静脉手术中，其次是非血管手术（33%）和动脉手术（10.6%）。30天死亡率为30.5%。CPA的独立预测因素包括肺部疾病（调整后比值比[aOR]16.79，95%置信区间[CI]2.334 - 195.3，p = 0.0097）、急诊手术（aOR 11.63，95% CI 2.517 - 72.46，p = 0.0035）、全身麻醉（aOR 19.41，95% CI 1.854 - 491.8，p = 0.0254）和镇静（aOR 13.04，95% CI 2.081 - 118.8，p = 0.0108）。30天死亡率的预测因素为CPA（aOR 9.830，95% CI 2.439 - 66.66，p = 0.0045）和作为并发症的低血压（aOR 16.81，95% CI 3.766 - 122.3，p = 0.0009）。
结论
我们的研究结果突出了接受IR手术患者的复杂性以及识别高危患者以预防IR环境中不良事件的重要性。
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