大規模な手術前出血と脳卒中またはQ波心筋梗塞との関連性
Hooman Kamel1, S Claiborne Johnston, John C Kirkham
1Department of Neurology and Neuroscience, Weill Cornell Medical College, New York, NY 10065, USA. hok9010@med.cornell.edu
Circulation
|June 9, 2012
まとめ
手術中の大きな出血は,患者の脳卒中や心臓発作のリスクを大幅に高めます. この発見は,外科的な環境における出血と血管疾患の管理に関するさらなる研究の必要性を強調しています.
科学分野:
- 周術医療 (Perioperative Medicine) とは,外科手術の際の治療法である.
- 血管外科 血管外科
- クリティカルケア・メディシン
背景:
- 血液出血は,心臓病患者における不全性合併症の既知の危険因子です.
- 一般的な外科手術の患者の間での手術前出血と不血性イベントの関係は不明である.
研究 の 目的:
- 大規模な手術前出血と成人手術患者の脳卒中または心筋梗塞の発生率との関連を調査する.
- 非心臓,非神経外科手術の際に大出血があるかどうかを判断するには,その後の血管イベントを独立して予測できます.
主な方法:
- 国家外科医療品質改善プログラム (2005年~2009年) のデータ分析.
- 非急性,非トラウマ,非移植,非心臓,非神経外科手術を受ける成人の患者を含む.
- 重度の出血は,赤血球パック4単位以上または全血輸血;脳卒中は,血管原因で24時間以上続く;心筋梗塞は,新しいEKG Q波である.
- コックス比率的な危険性モデルは,共変数を制御し,独立した関連性を評価するために使用されます.
主要な成果:
- 651,775人の患者のうち,0.80%が大きな出血を経験し,0.24%がQ波心筋梗塞,0.20%が脳卒中を患った.
- 大規模な手術前出血は,独立して脳卒中リスクの2.5倍増加と関連していました (HR 2.5,95% CI 1.9-3.3).
- 重度の手術前出血は,独立してQ波性心筋梗塞のリスク2.7倍増加と関連していました (HR2.7,95%CI 2.1-3.4).
結論:
- 大規模な手術前出血は,心臓外科,神経外科手術を受けていない患者で,その後の脳卒中および心筋梗塞の有意な独立した予測因子です.
- 発見は,出血と血管イベントの両方のリスクを軽減するために,抗血小板薬の使用などの手術後の戦略を評価するために,ランダム化試験の潜在的な必要性を示唆しています.
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