大型外科手术期间出血和中风或Q波心肌梗塞之间的关联
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
概括
在手术期间出现严重出血显著增加了患者中风和心脏病发作的风险. 这一发现强调了需要进一步研究在手术环境中管理出血和血管事件的必要性.
科学领域:
- 在外科手术期间的医学.
- 血管外科 血管外科
- 关键护理医学 关键护理医学
背景情况:
- 出血是心脏病患者缺血并发症的已知危险因素.
- 在一般手术患者中,术后出血和缺血事件之间的关系尚不清楚.
研究的目的:
- 研究成年外科手术患者的大型术后出血与中风或心肌梗塞发生率之间的关联.
- 为了确定非心脏,非神经外科手术期间是否有重大出血,可以独立预测随后的血管事件.
主要方法:
- 来自国家外科质量改善计划 (2005-2009) 数据的分析.
- 包括接受非急诊,非创伤,非移植,非心脏和非神经外科手术的成年患者.
- 大型出血的定义是大于4个单位的红细胞或全血输血;中风是血管原因持续时间≥24小时;心肌梗塞是新的心电图Q波.
- 考克斯的比例危险模型用于控制共变量和评估独立的关联.
主要成果:
- 在651,775名患者中,0.80%的患者经历了严重出血,0.24%的患者患有Q波心肌梗塞,0.20%的患者患有中风.
- 大型外科手术期间出血与中风风险增加2.5倍独立相关 (HR 2.5,95% CI 1.9-3.3).
- 大型外科手术期间出血与Q波心肌梗塞风险增加2.7倍独立相关 (HR2.7,95% CI 2.1-3.4).
结论:
- 大型外科手术期间出血是后续中风和心肌梗塞的重要独立预测因子,在接受非心脏,非神经外科手术的患者中.
- 这些发现表明,可能需要随机试验来评估外科手术期间的策略,例如使用抗血小板药物,以减轻出血和血管事件的风险.
相关概念视频
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management
458
Patients with hypertrophic cardiomyopathy (HCM) and left ventricular outflow tract (LVOT) obstruction who remain symptomatic despite optimal medical therapy may undergo a septal myectomy (Morrow procedure). This procedure involves excising a portion of the hypertrophied septum below the aortic valve using a heart-lung machine to improve blood flow through the LVOT. Effective preoperative and postoperative nursing management ensures successful patient outcomes, minimizes complications, and...
458
01:29Stroke: Introduction and Types
48
A stroke is an acute neurological event caused by the sudden disruption of cerebral blood flow, leading to rapid loss of neuronal function. Neurons depend on continuous oxygen and glucose supply, so even brief interruptions can cause irreversible injury within minutes. Strokes are classified into ischemic and hemorrhagic types.Ischemic StrokeIschemic strokes are most common and occur due to arterial occlusion, depriving brain tissue of oxygen and nutrients. This leads to energy failure, ionic...
48
01:15Ischemic Stroke l: Introduction
38
Ischemic stroke is an acute cerebrovascular condition in which blood flow to a brain region is suddenly interrupted, leading to tissue infarction. Neurons depend on continuous oxygen and glucose supply, so even brief reductions in perfusion cause energy failure, ionic imbalance, and irreversible injury. Ischemic strokes are classified into thrombotic and embolic types based on their underlying mechanisms.Thrombotic MechanismsThrombotic stroke develops when a clot forms within a cerebral artery.
38
01:15Ischemic Stroke ll: Pathophysiology
51
An ischemic stroke occurs when a cerebral blood vessel becomes obstructed, most often by a thrombus or embolus, interrupting the delivery of oxygen and glucose to brain tissue. Because neurons rely on continuous aerobic metabolism, energy failure begins within minutes of reduced perfusion. The region receiving the least blood flow becomes the infarct core, an area of irreversible cellular death. Surrounding this core lies the penumbra, a zone of hypoperfused but still viable tissue that is...
51
01:17Hemorrhagic Stroke l: Introduction
20
A hemorrhagic stroke is an acute neurological event that occurs when a weakened cerebral blood vessel ruptures, allowing blood to accumulate within or around the brain. The sudden release of blood forms a focal hematoma that increases intracranial pressure, displaces neural tissue, and can obstruct cerebrospinal fluid pathways. These effects may be compounded by intraventricular extension of the hemorrhage, cerebral edema, or compression of adjacent structures, all of which contribute to...
20
01:29Hemorrhagic Stroke ll: Pathophysiology
23
A hemorrhagic stroke develops when a cerebral blood vessel ruptures, allowing blood to escape into the surrounding brain tissue, as in intracerebral hemorrhage (ICH), or into the subarachnoid space, as in subarachnoid hemorrhage (SAH). Because the skull is a rigid compartment, the sudden presence of extravascular blood rapidly increases intracranial pressure and compresses adjacent neural structures, leading to immediate tissue injury and impaired cerebral perfusion.Mass Effect and Primary...
23