交感电风暴患者应用右美托咪定与预后的关系

The association of dexmedetomidine with outcomes in the treatment of patients with electrical storm

目的评估右美托咪定联合抗心律失常药物(AADs)是否能够改善交感电风暴(ES)患者的预后。方法本研究为回顾性队列研究,筛选2012年1月至2021年6月期间于泰达国际心血管病医院心脏监护室(CCU)接受过心脏电转复术或电除颤的患者,纳入诊断为ES的患者,ES定义为24小时内发生≥3次需立即予电转复或药物转复的持续性室性心动过速(VT)或心室颤动(VF)。根据患者是否接受了右美托咪定治疗,分为未接受右美托咪定组(接受标准AADs治疗)和接收右美托咪定组(标准AADs治疗联合右美托咪定)。从医院数据库中收集患者的基线资料,比较分析未接受右美托咪定组与接收右美托咪定组的临床结局,包括治疗后ES的终止率,患者的院内死亡率及出院后12个月的全因病死率)。采用多因素logistic回归分析方法评估使用右美托咪定对上述临床结局的预测价值。采用多因素Cox回归分析方法评估使用右美托咪定对出院后12个月时的全因病死的预测价值。结果共纳入74名ES患者。其中,未接受右美托咪定组和接受右美托必定组患者分别为38例和36例。与未接受右美托咪定治疗的患者比较,接受右美托咪定治疗的患者ES终止率更高(39%比89%,P<0.001),出院时存活率更高(66%比92%,P=0.01),出院后12月时存活率也更高(29%比67%,P=0.001)。多因素logistic回归分析结果显示,使用右美托咪定与降低的持续ES比例[校正的比值比(odds ratio,OR)0.046,95%可信区间(confidence interval,CI)0.010~0.214,P<0.001)],降低的院内病死率(校正的OR 0.005,95%CI 0.001~0.330,P=0.013)和降低的出院后12个月全因病死率(校正的OR 0.097,95%CI 0.021~0.437,P=0.002)独立相关。多因素Cox回归分析结果显示,使用右美托咪定与ES患者出院后12月时降低的全因病死率[校正的风险比(hazard ratio,HR)0.410,95%CI 0.212~0.795,P=0.008)]独立相关。结论在本次纳入过去十年所有交感电风暴患者的单中心回顾性队列研究中,右美托咪定的使用与降低的持续电风暴比例,降低的院内病死率及出院后12个月全因病死率等显著相关,未来需要进一步研究证实上述研究成果。

Objective To evaluate whether dexmedetomidine(DEX)in combination with antiarrhythmic drugs(AADs)could improve the outcomes of patients with electrical storm(ES).Methods This was a retrospective cohort study.Patients who received cardioversion or defibrillation between January 2012 and June 2021 in cardiac care unit(CCU)of TEDA International Cardiovascular Hospital in Tianjin,China,were initially screened and those diagnosed with ES,which was defined as≥3 episodes of sustained ventricular tachycardia(VT)or ventricular fibrillation(VF)within a 24-hour period were enrolled and divided into Non-DEX group(patients treated with standard AADs only)and DEX group(patients treated with standard AADs plus dexmedetomidine).Baseline characteristics were collected from the hospital database and the outcomes were compared between the two groups,including termination rate of ES after treatment,in-hospital mortality(IHM)and all-cause mortality(ACM)at 12 month after discharge.The prognostic value of DEX for the abovementioned outcomes were evaluated by multivariate logistic regression and for ACM during 12-month follow-up by multivariate Cox regression.Results A total of 74 patients with ES were enrolled and 38 were divided into Non-DEX group and other 36 patients into DEX group.Compared to those in the Non-DEX group,patients in the DEX group had a significantly higher termination rate of ES(39%vs.89%,P<0.001),higher survival rate at discharge(66%vs.92%,P=0.01)and higher survival rate at 12 months after discharge(29%vs.67%,P=0.001).Multivariate logistic regression analysis suggested that using of dexmedetomidine was independently associated with reduced rates of persisted ES[adjusted odds ratio(OR)0.046,95%confidence interval(CI)0.010-0.214,P<0.001],reduced IHM(adjusted OR 0.005,95%CI 0.001-0.330,P=0.013)and reduced ACM at 12 months after discharge(adjusted OR 0.097,95%CI 0.021-0.437,P=0.002).Moreover,multivariate Cox regression analysis showed that application of dexmedetomidine was independently associated with reduced ACM during the 12-month follow-up after discharge(adjusted hazard ratio 0.410,95%CI 0.212-0.795,P=0.008).Conclusion In this retrospective cohort study including all ES patients during the past decade at a single center,using of dexmedetomidine was significantly associated with reduced rates of persisted ES,IHM and ACM at 12 month after discharge,which need further prospective studies to confirm.