腹腔动脉瘤的初级护理查:美国预防服务工作组的最新证据报告和系统审查
Janelle M Guirguis-Blake1,2, Tracy L Beil2, Caitlyn A Senger2
1Department of Family Medicine, University of Washington, Tacoma.
JAMA
|December 11, 2019
概括
对65岁以上的男性进行腹腔大动脉瘤 (AAA) 查可以减少AAA相关的死亡和破裂. 然而,查并没有改善全因死亡率和增加手术率,而没有长期改善生活质量.
科学领域:
- 血管外科
- 预防医学
- 公共卫生
背景情况:
- 腹腔大动脉瘤破裂的死亡率很高,估计为81%.
- 有效的查和治疗策略对于改善患者的结果至关重要.
研究的目的:
- 系统审查AAA查的好处和危害的证据.
- 评估小动脉瘤治疗的疗效.
- 为美国预防服务工作组提供指导方针.
主要方法:
- 随机临床试验 (RCT) 和队列研究的系统审查和元分析.
- 通过MEDLINE,PubMed,DARES和Cochrane图书馆搜索到2018年9月,并通过2019年7月进行监视.
- 与AAA相关的死亡率和破裂率的合并概率 (ORs),以及所有原因死亡率的风险比率.
主要成果:
- 65岁以上男性的查邀请与12至15年的AAA相关死亡率 (OR,0. 65) 和破裂率 (OR,0. 62) 的降低有关.
- 在12至15岁时,查与全因死亡率的好处 (RR,0.99) 之间没有显著的关联.
- 查导致手术增加 (OR,1.44),但没有改善长期生活质量.
- 与监测相比,小AAA (3.0- 5. 4厘米) 的治疗没有显示死亡率的好处,但增加了手术.
- 在女性中,小动脉瘤治疗导致的手术并发症和术后死亡率较高.
结论:
- 在65岁以上的男性中,一次性AAA查降低了AAA相关的死亡率和破裂率.
- 查并没有给所有死因带来好处,而且增加了手术干预.
- 目前的证据不支持对小AAA进行早期手术.
- 治疗小动脉瘤的女性面临更高的风险.
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