结合肉症和ASA状态来告知紧急腹腔切除术的结果:这么简单吗?
Yan Joyce Ming1,2, Peter Howley3, Merran Holmes1,2,3
1Department of Surgery, John Hunter Hospital, Newcastle, New South Wales, Australia.
ANZ journal of surgery
|May 30, 2023
概括
虚弱度,以psoas肌肉与第3腰椎面积比率 (PM:L3) 来衡量,结合美国麻醉学会 (ASA) 分类,为紧急腹腔切除术 (EL) 患者提供了简单但有效的风险评估. 这种方法与预测死亡率的既定工具相竞争.
科学领域:
- 手术结果研究研究.
- 老年人手术是一门老年人手术.
- 放射学评估 放射学评估
背景情况:
- 紧急腹腔切除术 (EL) 风险评估对于术后护理至关重要.
- 既有工具 (ACS-NSQIP,NELA,P-POSSUM) 预测死亡率,但可能无法完全捕捉脆弱性.
- 在CT扫描上,肌与第3个腰椎的面积比率 (PM:L3) 与EL患者死亡率的反向关联.
研究的目的:
- 评估PM:L3和美国麻醉学会 (ASA) 简化分类在预测紧急腹腔切除术后死亡率方面的有效性.
- 将PM:L3和简化ASA模型的预测性能与已知的风险计算器进行比较.
主要方法:
- 追溯分析500名来自澳大利亚四家医院的EL患者 (2016-2017年) 的CT扫描.
- 放射性萨尔科佩尼亚测量为PM:L3比率;ACS-NSQIP,NELA和P-POSSUM计算.
- 使用后勤回归来评估PM:L3,简化ASA,并确定得分作为死亡率预测指标.
主要成果:
- PM:L3,简化的ASA,ACS-NSQIP,NELA和P-POSSUM是30日,90日和365日死亡率 (P<0.001) 的重要预测因素.
- 一个结合PM:L3和简化ASA的模型显示出强大的预测性能 (AUC 0.775-0.838),与ACS-NSQIP和NELA可比.
- 与单独的PM:L3相比,组合模型显示出更高的预测能力.
结论:
- 将简化ASA分类与PM:L3相结合,为复杂的风险评估得分提供了一个快速而简单的替代方案.
- 这种综合方法优于单独使用PM:L3来预测EL患者的死亡率.
- 这些发现支持将使用PM:L3和ASA分类的脆弱性评估纳入常规EL风险分层.
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