在接受重大头手术的患者中慢性心力衰竭:一项医院研究
Ivan A Alvarez1, Liam Ordoyne1, Grant Borne1
1LSU Health Shreveport, Dept. of Otolaryngology-HNS, United States of America.
American journal of otolaryngology
|September 21, 2023
概括
患有慢性心力衰竭且接受重大头癌手术的患者面临更高的住院死亡和非例行出院风险. 这突显了心力衰竭对这一群体手术结果的关键影响.
科学领域:
- 在瘤学瘤学.
- 心脏病学 心脏病学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 主要的头癌手术带有很大的术后风险.
- 慢性心力衰竭 (CHF) 是一种普遍的并发症,可能会影响手术结果.
- 了解这种手术患者群体中与CHF相关的特定风险对于患者管理至关重要.
研究的目的:
- 调查先前存在的慢性心力衰竭对经过头癌手术的大型手术的患者手术后结果的影响.
- 量化CHF和不良事件 (如死亡率和出院处置) 之间的关联.
主要方法:
- 使用2017-2019年全国住院患者样本 (NIS) 进行的回顾性队列研究.
- 包括10002名接受头癌重大手术 (如喉腔切除,部解剖) 的患者.
- 分析使用单变量和多变量逻辑回归来评估CHF对结果的影响.
主要成果:
- 总共有2.6%的患者被诊断为慢性心力衰竭.
- 慢性心血管疾病患者出现了较高的先前并发症负担 (4±1比2±1).
- 多变量分析显示,CHF患者的住院死亡率 (OR 2.86) 和非例行出院率 (OR 1.89) 的几率显著增加.
结论:
- 慢性心力衰竭与头癌患者的不良术后结果有显著的相关性.
- 这些结果包括增加住院死亡率和更高的非例行出院的可能性.
- 在接受重大头癌手术的患者中,应优化慢性心血管疾病的管理,以减轻风险.
相关概念视频
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management
15
Patients with hypertrophic cardiomyopathy (HCM) and left ventricular outflow tract (LVOT) obstruction who remain symptomatic despite optimal medical therapy may undergo a septal myectomy (Morrow procedure). This procedure involves excising a portion of the hypertrophied septum below the aortic valve using a heart-lung machine to improve blood flow through the LVOT. Effective preoperative and postoperative nursing management ensures successful patient outcomes, minimizes complications, and...
15
01:30Heart Failure VII: Nursing Interventions
89
The first step in nursing management of a patient with heart failure involves thoroughly assessing the patient's medical history.Subjective Data: Obtain the patient's medical history of coronary artery disease, hypertension, myocardial infarction, and symptoms like dyspnea, orthopnea, and paroxysmal nocturnal dyspnea.Objective Data: Conduct a physical examination to identify findings such as jugular vein distention, pulmonary crackles, tachycardia, murmurs, peripheral edema, and vital signs,...
89
01:30Heart Failure V: Medical Management
12
Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
12
01:22Heart Failure VI: Adjunct Therapies
16
Additional therapies for treating patients with heart failure (HF) may include procedural interventions, supplemental oxygen, the management of sleep disorders, and nutritional therapy.Procedural InterventionsImplantable Cardioverter-Defibrillator: For patients at risk of life-threatening arrhythmias due to severe left ventricular dysfunction, an Implantable Cardioverter-Defibrillator (ICD) can detect and terminate these arrhythmias, preventing sudden cardiac death and improving survival rates.
16
01:27Heart Failure I: Introduction
14
Heart failure refers to a clinical syndrome caused by structural or functional cardiac disorders that prevent the heart from pumping an adequate amount of blood to meet the body's metabolic needs. This condition often arises from myocardial infarction or ischemia, leading to decreased cardiac output, reduced tissue perfusion, impaired gas exchange, fluid volume imbalance, and decreased functional ability.Heart failure can result from disruptions in the mechanisms that regulate cardiac output...
14
01:22Aneurysm IV: Nursing Management
8
Vigilant monitoring for aneurysm rupture is essential for patients undergoing aortic surgery.Preoperative Nursing ManagementContinuously monitor the patient for manifestations of aneurysm rupture, such as pallor, weakness, tachycardia, hypotension, abdominal, back, groin, or periumbilical pain, changes in consciousness, and a pulsating abdominal mass. Regularly assess the patient's peripheral pulses.Instruct the patient to consume a clear liquid diet the day before surgery and administer...
8