患有重大血管外科手术的患者的术后死亡风险预测模型,特别关注破裂的腹腔大动脉动脉瘤:范围审查
Alessandro Grandi1, Luca Bertoglio2, Sandro Lepidi3
1Department of Vascular Medicine, University Heart and Vascular Center, 20251 Hamburg, Germany.
Journal of clinical medicine
|September 9, 2023
概括
这次审查发现了破裂腹腔大动脉动脉瘤 (rAAA) 手术的多个风险评分,但由于数据多样化,没有一个是绝对优越的. 需要进行进一步的研究,以确定术后死亡率的最佳预测工具.
科学领域:
- 血管外科 血管外科
- 外科手术的结果
- 风险预测 风险预测
背景情况:
- 血管外科手术中的术后死亡率,特别是腹腔大动脉动脉瘤破裂 (rAAA),需要准确的风险评估.
- 现有的风险预测指数旨在指导临床决策和患者管理.
研究的目的:
- 对常见报告的血管外科手术中术后死亡率风险预测指数的临床数据进行范围审查.
- 特别关注破裂腹腔大动脉动脉瘤 (rAAA) 的风险预测.
主要方法:
- 在PRISMA协议扩展后进行了范围审查.
- 来自PubMed,Cochrane和EMBASE数据库的全文英语研究的系统审查和分析.
- 用于搜索字符串的PICO框架:患有大动脉病理 (特别是rAAA) 的患者,开放式或内血管手术,风险预测模型和术后死亡率预测.
主要成果:
- 在最终的定性综合中,包括了56项研究.
- 确定了9个主要血管手术/选择性AAA的风险得分和10个rAAA的风险得分.
- 虽然许多分数显示了rAAA的充足性能,但没有一个达到100%的准确性. 格拉斯哥动脉瘤得分,ERAS和温哥华得分经常得到验证. 使用的结果和变量的异质性限制了比较分析. 目前,血管外科协会没有认可任何评分.
结论:
- 风险分数在复杂和新出现的手术中提供优势,如rAAA,通过告知决策和讨论.
- 尽管有众多的rAAA风险预测工具,但本次审查没有发现由于变量和验证结果的异质性而导致的单一优异得分.
- 未来的进展,可能涉及人工智能,可能会改善手术后不良事件预测在手术决策.
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