心弁置換術後の血栓栓塞栓リスクを決定するための新しいスコアリングシステム
Eric G Butchart1, Adrian Ionescu, Nicola Payne
1Department of Cardiothoracic Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK. egbutchart@aol.com.
Circulation
|September 13, 2003
まとめ
炎症および血液学的マーカーは,臨床的要因とともに,弁置換術 (VR) の患者の血栓栓塞栓症 (TE) リスクを予測することができます. これらの予測値を用いたスコア付けシステムは,治療決定を導くことができます.
科学分野:
- 心血管医学 心血管医学
- 血液学 ヘマトロジ
- 感染症 感染症とは
背景:
- 血栓栓塞栓症 (TE) は,弁置換手術 (VR) の後の重大なリスクです.
- 正確な術前リスクの分層化は,患者の管理に不可欠です.
- 伝統的な臨床的要因を超えた信頼性の高い予測要因を特定することが必要です.
研究 の 目的:
- VR患者におけるTEの主要な炎症および血液学的予測因子を特定する.
- TEの術前リスクプロファイリングのためのスコアシステムを開発する.
- 義肢選択と抗血栓症管理戦略を参考にすること.
主な方法:
- 370人のVR患者の臨床,エコー,心臓,血液,微生物学的パラメータの見通し調査.
- 平均4.4年の追跡期間におけるTEイベントの予測要因を特定するための多変量分析.
- 特定されたリスク要因に基づく追加スコアリングシステムの開発.
主要な成果:
- 大動脈弁置換 (AVR) の後のTEの予測要因には,クラミジア肺炎 (CP) 感染症,以前のTE,エオシノフィルの上昇,がん歴,術後の感染症,高血圧,CABG,糖尿病が含まれています.
- ミトラ弁置換術 (MVR) /DVR後のTEの予測要因には,平均血小板量増加,因子VII増加,CP感染,前回のミトラ弁切除術,フィブリノゲンの増加,および網膜細胞の増加が含まれています.
- アディティブスコアリングシステムは,存在するリスク要因の数に基づいて,TEリスクを正確に予測しました.
結論:
- 選択された血液検査と臨床的要因は,VR患者のTEリスクを効果的に予測します.
- 開発されたスコアリングシステムは,手術前リスク評価に役立ちます.
- 発見は,義肢選択と抗血栓治療の指針となり得る.
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