目的:心血管异常在威廉姆斯综合征患者中很常见,并且在具有独特神经精神特征的人群中,经常需要手术干预,需要镇痛和镇静。潜在增加围手术期心脏不良事件的风险.尽管有这种风险,心脏重症监护病房的WS患者的总体术后镇痛药物需求尚未得到调查.我们的主要目的是与对照组相比,检查心脏手术后WS患者的镇静剂需求。我们的次要目的是比较两组之间主要ACE的频率和死亡率。
方法:匹配的病例对照研究。
方法:在三级儿童医院的PediatricCICU。
方法:在2014年7月至2021年1月期间接受心脏手术并在心脏手术后接受CICU的WS患者和年龄匹配的对照组。
方法:无。
结果:收集研究组术后前6天的术后结局和镇痛药物的总剂量。WS的中位年龄为29.8(12.4-70.8)个月,对照组为23.5(11.2-42.3)个月。在所有研究间隔(48小时和术后前6天),吗啡当量的总剂量组间没有差异(5.0mg/kgvs5.6mg/kg,p=0.7和8.2mg/kgvs10.0mg/kg,p=0.7),咪达唑仑当量(1.8mg/kgvs1.5mg/kg,p=0.4和3.4mg/kgvs.3.8mg/kg,p=0.4),或右美托咪定(20.5mcg/kgvs24.4mcg/kg,p=0.5和42.3mcg/kgvs39.1mcg/kg,p=0.3)。主要ACE的频率或死亡率没有差异。
结论:与对照组相比,患有WS的患者接受了相似的镇痛药物剂量。主要ACE(包括心脏骤停,体外膜氧合,和手术再干预)或两组之间的死亡率,尽管这些发现必须谨慎解释。需要进一步研究以阐明疼痛/镇静控制的充分性,这些因素可能会影响这个独特人群的药物需求,以及对临床结果的影响。
OBJECTIVE: Cardiovascular abnormalities are common in patients with Williams syndrome and frequently require surgical intervention necessitating analgesia and sedation in a population with a unique neuropsychiatric profile, potentially increasing the risk of adverse cardiac events during the perioperative period. Despite this risk, the overall postoperative analgosedative requirements in patients with WS in the cardiac intensive care unit have not yet been investigated. Our primary aim was to examine the analgosedative requirement in patients with WS after cardiac surgery compared to a control group. Our secondary aim was to compare the frequency of major ACE and mortality between the two groups.
METHODS: Matched
case-control study.
METHODS: Pediatric CICU at a Tertiary Children\'s Hospital.
METHODS: Patients with WS and age-matched controls who underwent cardiac surgery and were admitted to the CICU after cardiac surgery between July 2014 and January 2021.
METHODS: None.
RESULTS: Postoperative outcomes and total doses of analgosedative medications were collected in the first six days after surgery for the study groups. Median age was 29.8 (12.4-70.8) months for WS and 23.5 (11.2-42.3) months for controls. Across all study intervals (48 h and first 6 postoperative days), there were no differences between groups in total doses of morphine equivalents (5.0 mg/kg vs 5.6 mg/kg, p = 0.7 and 8.2 mg/kg vs 10.0 mg/kg, p = 0.7), midazolam equivalents (1.8 mg/kg vs 1.5 mg/kg, p = 0.4 and 3.4 mg/kg vs 3.8 mg/kg, p = 0.4), or dexmedetomidine (20.5 mcg/kg vs 24.4 mcg/kg, p = 0.5 and 42.3 mcg/kg vs 39.1 mcg/kg, p = 0.3). There was no difference in frequency of major ACE or mortality.
CONCLUSIONS: Patients with WS received similar analgosedative medication doses compared with controls. There was no significant difference in the frequency of major ACE (including cardiac arrest, extracorporeal membrane oxygenation, and surgical re-intervention) or mortality between the two groups, though these findings must be interpreted with caution. Further investigation is necessary to elucidate the adequacy of pain/sedation control, factors that might affect analgosedative needs in this unique population, and the impact on clinical outcomes.