胰岛素依赖与AAA修复后的长期不良结果有关
Molly Ratner1, Clay Wiske1, Caron Rockman1
1Division of Vascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY.
Annals of vascular surgery
|August 16, 2023
概括
胰岛素依赖性糖尿病在腹腔大动脉瘤修复后增加风险,死亡率和再入院率更高. 这表明应该重新考虑这些患者的修复值.
科学领域:
- 血管外科 血管外科
- 糖尿病学 糖尿病学
- 健康 结果 研究 研究 结果
背景情况:
- 已知糖尿病可以防止腹腔大动脉动脉瘤 (AAA) 的发展.
- 然而,糖尿病,特别是胰岛素依赖对AAA修复后的结果的影响仍然不太清楚.
研究的目的:
- 调查胰岛素依赖性糖尿病与开放和内血管AAA修复后的短期和长期结果之间的联系.
主要方法:
- 利用VISION注册表,将VQI和Medicare索赔联系起来,用于接受AAA修复的患者 (2011年至今).
- 排除了未知糖尿病状况,先前的大动脉干预,小动脉瘤 (<45毫米) 或Medicare Advantage覆盖范围的患者.
- 按糖尿病状况和胰岛素依赖性分层的患者.
主要成果:
- 接受血管内大动脉动脉瘤修复 (EVAR) 的糖尿病患者患上术后心肌梗塞和30天再入院的比率更高.
- 胰岛素依赖性糖尿病 (IDDM) 患者在开放性大动脉动脉瘤修复 (OAR) 和EVAR方面面临30天再入院的增加.
- 接受EVAR治疗的IDDM患者在手术后1,3年和5年出现更高的死亡风险,而OAR患者的5年死亡风险增加.
结论:
- 与其他患者 (8%) 相比,依赖胰岛素的糖尿病在AAA修复后的一年死亡率 (>14%) 与其他患者 (8%) 相比明显更高.
- 研究结果表明,可能需要重新评估在胰岛素依赖的糖尿病患者中预防性AAA修复的尺寸值.
- 需要进一步的研究来探索血糖控制对这些结果的影响.
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