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在心脏手术中减少过度失血的药理学策略:对临床相关终点的元分析
M Levi1, M E Cromheecke, E de Jonge
1Department of Vascular Medicine, Academic Medical Centre, University of Amsterdam, The Netherlands. m.m.levi@amc.uva.nl
Lancet (London, England)
|January 6, 2000
概括
药理学策略,如阿普罗丁宁和氨酸类似物,显著降低心脏手术患者的死亡率和回胸切除率. 这些药物还减少了对输血的需求,改善了患者的治疗结果.
科学领域:
- 心脏病学 心脏病学
- 药理学 药理学是指药理学的学科.
- 临界护理医学 临界护理医学
背景情况:
- 过度出血是心脏手术的重要并发症,增加了发病率和死亡率.
- 以前的试验表明,药理学药物可以减少血液流失,但往往缺乏临床结果的力量.
- 进行了对阿普罗丁宁,氨酸类似物和德斯摩素进行分析,以减少外科手术期间的出血.
研究的目的:
- 评估三种药理学策略在心脏手术中减少术后出血的疗效.
- 评估这些策略对临床相关结果的影响,包括死亡率和输血率.
主要方法:
- 72个随机对照试验的元分析,涉及8409名患者.
- 纳入标准要求报告临床结果 (死亡率,回胸切除术,输血,心肌梗塞) 以及血液损失.
- 针对复杂心脏手术研究的单独分析.
主要成果:
- 阿普罗丁因几乎减半了死亡率 (OR 0.55) 和,用氨酸类似物,降低了回胸切除率 (OR 0.37-0.44).
- 无论是aprotinin还是lysine类似物,都显著降低了全基因输血需求.
- 德斯莫普林显示,在没有临床益处的情况下,血流减少最小,心肌梗塞风险增加 (OR 2.4).
结论:
- 药理学药物,特别是阿普罗丁宁和氨酸类似物,有效地减少心脏外科手术中的外科手术期间的血液损失.
- 这些药物与降低死亡率,回切除术和输血率有关.
- 由于缺乏临床益处和心肌梗塞风险增加,不建议使用德斯莫普林素.
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