大型腹部手术后的术后系统性炎症:以患者为中心的结果
C R Bain1, P S Myles1, C Martin2
1Department of Anaesthesiology and Peri-operative Medicine, Alfred Hospital and Monash University, Melbourne, VIC, Australia.
Anaesthesia
|August 2, 2023
概括
高度的手术后炎症显著增加了重大腹部手术后90天内残疾或死亡的风险. 这种系统性炎症也会对患者的康复质量产生负面影响,强调需要更好的管理策略.
科学领域:
- 手术成果研究的研究结果.
- 炎症和免疫学 炎症和免疫学
- 患者为中心的护理
背景情况:
- 手术后的全身炎症与手术结果有关,但它对以患者为中心的结果的影响尚不清楚.
- 确定与患者不良结果相关的因素对于开发预防性治疗至关重要.
- 这项研究探讨了手术后炎症和高风险手术患者的以患者为中心的结果之间的关系.
研究的目的:
- 检查不同程度的术后系统性炎症与以患者为中心的结果之间的关联.
- 根据炎症水平,确定术后90天内持续残疾或死亡的风险.
- 评估手术后炎症对3日和30日康复质量的影响.
主要方法:
- 从RELIEF试验中对3000名接受重大腹部手术的高风险患者进行了回顾性队列研究.
- 患者根据最大的术后C反应性蛋白 (CRP) 水平到第3天被分为四分之一.
- 同主终点包括持续残疾/死亡 (90天) 和恢复质量 (第3天和第30天的QoR-15得分).
主要成果:
- 术后系统性炎症的较高水平与持续残疾或死亡的调整后风险比率增加相关,长达90天 (四分位数4与四分位数1: 1.76).
- 炎症增加与风险调整后的康复质量得分在第3天和第30天显著下降相关.
- 显著的炎症与更高的并发症发生率,较差的恢复,持续的残疾或死亡有关.
结论:
- 显著的术后系统性炎症是主要腹部手术后以患者为中心的不良结果的关键预测因素.
- 手术后C-反应蛋白水平升高表明并发症风险更高,恢复质量降低,死亡率增加.
- 这些发现强调了监测和管理术后炎症的重要性,以改善患者的治疗结果.
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