对于患有外周动脉疾病,接受主要下肢截肢的人来说,使用带
Ryan Laloo1, Madlen Dewi2, Brenig L Gwilym2
1Leeds Vascular Institute, Leeds General Infirmary, Leeds, UK.
The Cochrane database of systematic reviews
|July 18, 2023
概括
环护显著减少了周围动脉疾病 (PAD) 的主要下肢截肢 (MLLAs) 的血液损失和输血需求. 然而,它们对伤口愈合和其他并发症的影响需要进一步的高确定性证据.
科学领域:
- 血管外科 血管外科
- 外科手术的结果
- 周围动脉疾病 (PAD) 周围动脉疾病
背景情况:
- 主要由于外周动脉疾病 (PAD) 而导致的主要下肢截肢 (MLLA) 是常见的,随着手术期间的大量血流造成风险.
- 护带用于在下肢手术中尽量减少出血,但由于对茎输液和伤口愈合的担忧,其在PAD患者的MLLA中的安全性和有效性受到争议.
研究的目的:
- 评估在MLLA治疗PAD并发症时使用带的安全性和有效性.
- 具体关注的是手术内流血,血红蛋白变化,输血率,伤口愈合,修复手术和术后并发症,包括死亡率.
主要方法:
- 系统地搜索多个数据库 (Cochrane Vascular,CENTRAL,MEDLINE,Embase,CINAHL) 和临床试验登记册,直到2022年5月.
- 包括一项随机对照试验 (RCT),比较在接受PADMLLA治疗的患者中使用轮与不使用轮.
- 主要结局:手术期间流血,血红蛋白降低和输血需求. 二次结果:伤口愈合,树修复,术后并发症和死亡率.
主要成果:
- 在单个包含的RCT (64名参与者) 中,在轮组中,手术内流血量 (255毫升相比550毫升) 显著减少.
- 轮使用与血红蛋白 (1.0 g/dL相比1.8 g/dL) 的明显较低下降,以及减少输血需求 (32%相比48%).
- 两组之间没有观察到伤口愈合,茎修复或术后并发症的显著差异. 证据确定性被评为低或非常低.
结论:
- 在PAD的MLLA中使用围护似乎可以减少手术期间的血液流失,血红蛋白下降和输血需求.
- 由于证据有限,轮对伤口愈合,茎部修复,术后并发症和死亡率的影响尚不清楚.
- 来自进一步研究的高确定性证据是必要的,以指导临床决策关于在这个患者群体中使用带.
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