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[article]
Titre : |
Evolution of life expectancy of patients with Duchenne muscular dystrophy at AFM Yolaine de Kepper centre between 1981 and 2011 |
Titre original : |
Évolution de l’espérance de vie des patients atteints de dystrophie musculaire de Duchenne au centre AFM Yolaine de Kepper entre 1981 et 2011 |
Type de document : |
texte imprimé |
Année de publication : |
2013 |
Article en page(s) : |
pp.443-454 |
Langues : |
Français (fre) |
Résumé : |
Objectifs
Étude rétrospective sur 30ans de l’espérance de vie des patients atteints de dystrophie musculaire de Duchenne (DMD). Analyse du rôle de la ventilation assistée et des causes de décès.
Patients et méthodes
Cent-dix-neuf patients adultes atteints de DMD ont séjourné au centre AFM Yolaine de Kepper, Saint-Georges-sur-Loire (France) entre 1981 et 2011. L’espérance de vie des patients a été calculée en utilisant le modèle de Kaplan-Meier.
Résultats
L’espérance de vie des patients atteints de DMD sans ventilation assistée était de 22,16ans et de 36,23ans pour ceux qui en ont bénéficié. L’espérance de vie des patients nés à partir de 1970 (et ainsi le plus souvent ventilés) était de 40,95ans et d’uniquement 25,77ans pour ceux nés avant 1970. Les causes de décès se sont également modifiées avec une progression des décès d’origine cardiaques de 8 % à 44 %.
Conclusion
La ventilation assistée et dans cette étude principalement par trachéotomie, permet de prolonger l’espérance de vie de plus de 15ans des patients atteints de DMD. Elle permet de conserver une qualité de vie satisfaisante et doit être systématiquement proposée aux patients. |
Permalink : |
./index.php?lvl=notice_display&id=24177 |
in Annals of physical and rehabilitation medicine > Vol. 56, n°6 (01/09/2013) . - pp.443-454
[article] Evolution of life expectancy of patients with Duchenne muscular dystrophy at AFM Yolaine de Kepper centre between 1981 and 2011 = Évolution de l’espérance de vie des patients atteints de dystrophie musculaire de Duchenne au centre AFM Yolaine de Kepper entre 1981 et 2011 [texte imprimé] . - 2013 . - pp.443-454. Langues : Français ( fre) in Annals of physical and rehabilitation medicine > Vol. 56, n°6 (01/09/2013) . - pp.443-454
Résumé : |
Objectifs
Étude rétrospective sur 30ans de l’espérance de vie des patients atteints de dystrophie musculaire de Duchenne (DMD). Analyse du rôle de la ventilation assistée et des causes de décès.
Patients et méthodes
Cent-dix-neuf patients adultes atteints de DMD ont séjourné au centre AFM Yolaine de Kepper, Saint-Georges-sur-Loire (France) entre 1981 et 2011. L’espérance de vie des patients a été calculée en utilisant le modèle de Kaplan-Meier.
Résultats
L’espérance de vie des patients atteints de DMD sans ventilation assistée était de 22,16ans et de 36,23ans pour ceux qui en ont bénéficié. L’espérance de vie des patients nés à partir de 1970 (et ainsi le plus souvent ventilés) était de 40,95ans et d’uniquement 25,77ans pour ceux nés avant 1970. Les causes de décès se sont également modifiées avec une progression des décès d’origine cardiaques de 8 % à 44 %.
Conclusion
La ventilation assistée et dans cette étude principalement par trachéotomie, permet de prolonger l’espérance de vie de plus de 15ans des patients atteints de DMD. Elle permet de conserver une qualité de vie satisfaisante et doit être systématiquement proposée aux patients. |
Permalink : |
./index.php?lvl=notice_display&id=24177 |
| ![Evolution of life expectancy of patients with Duchenne muscular dystrophy at AFM Yolaine de Kepper centre between 1981 and 2011 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) 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