术前血液透析时间与术后死亡率之间的关联
Vikram Fielding-Singh1, Matthew W Vanneman1, Tristan Grogan2
1Department of Anesthesiology, Perioperative, and Pain Medicine, School of Medicine, Stanford University, Stanford, California.
JAMA
|November 3, 2022
概括
在接受手术的患者中,血液透析和手术间隔较长会增加术后死亡风险. 在手术当天接受血液透析与较低的死亡率有关,减轻了透析程序间隔较长的风险.
科学领域:
- 肝脏病学
- 手术的结果
- 公共卫生
背景情况:
- 对于末期脏疾病 (ESKD) 患者,选择性手术前进行血液透析的最佳时间尚不清楚.
- 了解这一时机对于改善这一脆弱群体的手术结果至关重要.
研究的目的:
- 研究血液透析和手术之间的间隔与ESKD患者的90天术后死亡率之间的关联.
- 要确定当天的血液透析是否会影响这种关联.
主要方法:
- 对超过110万名患有ESKD的医疗保险受益人的回顾性队列研究.
- 血液透析和手术之间的1,2,3天间隔的分析,以及同一天的血液透析.
- 用于评估90天术后死亡率的Cox比例危险模型.
主要成果:
- 根据剂量,更长的血液透析至手术间隔与90天死亡风险的增加有关.
- 同日透析与没有同日透析相比,同日透析的死亡率显著降低.
- 同一天的血液透析减轻了与更长的透析程序间隔相关的死亡风险.
结论:
- 血液透析和手术之间的较长间隔增加了ESKD患者的术后死亡风险,特别是如果没有在同一天进行透析.
- 虽然在统计上显著,但死亡风险的绝对差异很小.
- 研究结果建议在接受手术的ESKD患者考虑当天进行血液透析,同时承认潜在的残留混.
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