视频辅助胸部手术 保持血胸部的疏散; 时间可能不会增加胸腔镜失败
Joep J J Ouwerkerk1, Elaine P X van Ee1, Tommy A Brown2
1Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Division of Trauma Surgery, Leiden University Medical Center, Leiden, Netherlands.
The Journal of surgical research
|September 29, 2023
概括
在创伤患者中,延迟视频辅助胸部手术 (VATS) 维持血胸 (rHTX) 与更长的住院时间有关,但不增加死亡率. 对rHTX进行临床必要的VATS延迟是可以接受的,而不会恶化患者的结果.
科学领域:
- 创伤外科 手术 创伤外科
- 胸部外科手术 胸部外科手术
- 关键护理医学 关键护理医学
背景情况:
- 目前的指导方针建议视频辅助胸部手术 (VATS) 在创伤患者的保留血胸 (rHTX) 中4天内进行.
- 这一建议是基于从小型观察性研究中获得的有限证据.
- 在rHTX中VATS的最佳时机需要进一步调查.
研究的目的:
- 评估VATS时间和rHTX创伤患者的临床结果之间的关联.
- 为了确定延迟VATS是否会影响住院时间,并发症或死亡率.
主要方法:
- 对2017-2019创伤质量改善计划数据库的分析.
- 包括接受VATS的rHTX的成年创伤患者 (≥15岁).
- 多变量回归模型评估了VATS时间和结果之间的关系,将延迟定义为一天后进行的手术.
主要成果:
- 总共有793名患者被纳入,VATS的中位数为4.5天.
- 延迟VATS的每一天与住院时间 (1.17天),术后时间 (0.17天),通风时间 (0.48天) 和重症监护室时间 (0.66天) 的增加有关.
- 延迟VATS也与更高的感染并发症几率和更低的退院几率相关;然而,没有发现与VATS故障,需要二次手术或死亡率有重大关联.
结论:
- 虽然rHTX的延迟VATS与资源利用率的增加有关,但临床意义不如以前所认为的那么明显.
- 没有证据表明延迟VATS会影响死亡率,出院处置或需要进一步的手术干预.
- 在适当的临床场景中,可以考虑推迟rHTX的VATS,而不影响患者的生存或需要额外的程序.
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