儿科Moyamoya重血管化术后护理:一个修改后的Delphi研究
Lisa R Sun1, Lori C Jordan2, Edward R Smith3
1Division of Cerebrovascular Neurology, Division of Pediatric Neurology, The Johns Hopkins School of Medicine, Baltimore, MD, USA. Lsun20@jhmi.edu.
Neurocritical care
|July 20, 2023
概括
专家们就儿科莫亚莫亚手术的术后护理达成共识,强调高风险患者的入院前治疗以及特定的液体,药物和监测协议. 它指导了儿童间接再血管化的最佳实践.
科学领域:
- 儿科神经外科 儿科神经外科
- 神经学 神经学
- 密集护理医学 密集护理医学
背景情况:
- 儿童的莫亚莫亚动脉病变具有显著的中风风险.
- 手术复血管化可以降低长期中风风险,但会带来外科手术期间的风险.
- 有限的基于证据的指导方针存在于小儿moyamoya手术的术后护理.
研究的目的:
- 建立专家的共识,为小儿 moyamoya 经过间接的再血管.
- 确定莫亚莫亚管理临床疗效领域的研究重点.
主要方法:
- 一个经过修改的Delphi过程,涉及30名北美儿科Moyamoya专家.
- 三轮包括一个调查,匿名的利克特评分表评估和一个虚拟会议.
- 共识定义为在88个陈述上达成80%以上的同意或不同意.
主要成果:
- 在39项关于间接再血管化的术后护理的陈述上达成共识.
- 关键协议包括高风险患者的入院前治疗,特定的静脉输液方案,持续使用阿司匹林,长时间的动脉线路监测和详细的术后护理 (每小时的生命体,神经检查,疼痛控制,正常热量/正常氧,避免低血压).
- 建议在手术后对新的焦点神经学缺陷进行静脉注射.
结论:
- 德尔菲过程定义了儿科moyamoya手术中术后护理的共识领域.
- 确定的研究重点包括连续EEG,最佳血压和血红蛋白目标,以及术后缺血症补充氧气的作用.
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