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内血管动脉瘤修复后急性功能衰竭的危险因素
Benjamin R Zambetti1, William P Zickler2, Saskya Byerly3
1Division of Vascular Surgery, University of Maryland, Baltimore, MD, USA.
The American surgeon
|July 25, 2023
概括
血管内大动脉动脉瘤修复 (EVAR) 后的急性功能衰竭 (ARF) 显著增加死亡率和住院时间. 风险因素包括更大的动脉瘤直径,更高的肌素,更长的手术时间和新出现的修复.
科学领域:
- 心血管外科心血管外科
- 腎臟病學 (nephrology) 是一種醫學專業.
- 医疗信息学 医疗信息学
背景情况:
- 血管内大动脉动脉瘤修复 (EVAR) 后的急性损伤 (AKI) 很少发生,但与严重的发病率有关.
- 在EVAR后需要透析的急性功能衰竭 (ARF) 的危险因素尚未确定.
- 这项研究旨在评估ARF对EVAR患者的影响,并确定相关的风险因素.
研究的目的:
- 评估在接受EVAR的患者中ARF的发生率和后果.
- 在EVAR群体中确定ARF的独立预测因子.
- 在EVAR后为ARF提供临床监测和风险分层信息.
主要方法:
- 从2011-2019年使用了国家外科质量改进计划 (NSQIP) 数据库.
- 鉴定了18347名接受EVAR的患者,并根据ARF的存在对其进行分层.
- 进行多变量后勤回归以确定ARF的独立预测因子.
主要成果:
- 234名患者 (1.3%) 患有需要透析的ARF.
- ARF与显著更高的死亡率 (40%对1.8%),长时间的ICU (5对0天) 和住院时间 (11对2天) 相关.
- 独立的ARF预测因素包括动脉瘤直径增加,肌素,手术时间,手术前输血,ASA类,突发性修复,女性性别,以及尾/尾降落区.
结论:
- 在EVAR之后的ARF导致相当大的发病率,延长住院时间和增加死亡率.
- 密切的患者监测对于那些在EVAR后面临ARF风险的人来说至关重要,以减轻不良结果.
- 识别和管理风险因素可能会降低ARF的发病率,并改善EVAR后患者的存活率.
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