背景:关于唐氏综合征对房室间隔缺损手术修复后结局的影响存在争议数据。
目的:(A)评估有或没有唐氏综合征的房室间隔缺损的趋势和结局,(B)确定与房室间隔缺损修复后不良结局相关的危险因素。
方法:我们使用国际疾病分类代码查询了2000年至2018年<1岁的房室间隔缺损患者的国家住院患者样本。患者特征,合并症,死亡率,通过比较有唐氏综合征和无唐氏综合征的人群来评估医疗保健利用率。
结果:总计,检查了2,318,706名冠心病患者;其中,61,101(2.6%)患有房室间隔缺损。在每年住院的所有CHD婴儿中,房室间隔缺损婴儿的住院发生率为4.5%至7.5%。共有33,453例(54.7%)患者与唐氏综合征相关。右心室双出口,主动脉缩窄,法洛四联症是最常见的与CHD相关的患者分别为6.9、5.7和4.3%,分别。总的房室间隔缺损死亡率为6.3%。多变量分析表明,早产,低出生体重,肺动脉高压,心脏传导阻滞与死亡率相关。唐氏综合征与肺动脉高压的发生率较高相关(4.3对2.8%,p<0.001),更少的心律失常(6.6对11.2%,p<0.001),机械通气的持续时间较短,住院时间缩短,围手术期死亡率较低(2.4%对11.1%,p<0.001)。
结论:随着时间的推移,房室间隔缺损住院的趋势是稳定的。房室间隔缺损的围手术期死亡率与早产有关,低出生体重,肺动脉高压,心脏传导阻滞,急性肾损伤,和败血症.唐氏综合征在超过一半的房室间隔缺损患者中存在,并且与肺动脉高压的发生率较高,但心律失常较少有关。死亡率较低,住院时间缩短,资源利用率较低。
BACKGROUND: Controversial data exist about the impact of Down syndrome on outcomes after surgical repair of atrioventricular septal defect.
OBJECTIVE: (A) assess trends and outcomes of atrioventricular septal defect with and without Down syndrome and (B) determine risk factors associated with adverse outcomes after atrioventricular septal defect repair.
METHODS: We queried The National Inpatient Sample using International Classification of Disease codes for patients with atrioventricular septal defect < 1 year of age from 2000 to 2018. Patients\' characteristics, co-morbidities, mortality, and healthcare utilisation were evaluated by comparing those with versus without Down syndrome.
RESULTS: In total, 2,318,706 patients with CHD were examined; of them, 61,101 (2.6%) had atrioventricular septal defect. The incidence of hospitalisation in infants with atrioventricular septal defect ranged from 4.5 to 7.5% of all infants hospitalised with CHD per year. A total of 33,453 (54.7%) patients were associated with Down syndrome. Double outlet right ventricle, coarctation of the aorta, and tetralogy of Fallot were the most commonly associated with CHD in 6.9, 5.7, and 4.3% of patients, respectively. Overall atrioventricular septal defect mortality was 6.3%. Multivariate analysis revealed that prematurity, low birth weight, pulmonary hypertension, and heart block were associated with mortality. Down syndrome was associated with a higher incidence of pulmonary hypertension (4.3 versus 2.8%, p < 0.001), less arrhythmia (6.6 versus 11.2%, p < 0.001), shorter duration for mechanical ventilation, shorter hospital stay, and less perioperative mortality (2.4 versus 11.1%, p < 0.001).
CONCLUSIONS: Trends in atrioventricular septal defect hospitalisation had been stable over time. Perioperative mortality in atrioventricular septal defect was associated with prematurity, low birth weight, pulmonary hypertension, heart block, acute kidney injury, and septicaemia. Down syndrome was present in more than half of atrioventricular septal defect patients and was associated with a higher incidence of pulmonary hypertension but less arrhythmia, lower mortality, shorter hospital stay, and less resource utilisation.