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抗血栓剂对腹膜下血液瘤疏散的影响:"逆转"真正意味着什么?
Danielle D Dang1, Luke A Mugge1, Purushotham Ramanathan2
11Department of Neurosurgery, Inova Fairfax Medical Campus, Falls Church, Virginia.
Neurosurgical focus
|October 1, 2023
概括
在需要紧急的腹膜下血瘤 (SDH) 手术的患者中,抗血栓治疗 (ATT) 的使用与更糟糕的结果有关. 逆转策略并没有显著改善结果,这凸显了需要仔细管理ATT的必要性.
科学领域:
- 神经外科 神经外科
- 关键护理医学 关键护理医学
- 血液学 血液学 血液学
背景情况:
- 对于在皮血瘤 (SDH) 患者紧急神经外科干预的抗血栓治疗 (ATT) 的最佳周术管理还没有得到很好的定义.
- 均衡血液静止和血栓形成预防是复杂的,受ATT类型,并发症和神经损伤程度的影响.
- 这项研究解决了在ATT接受紧急SDH疏散的高风险患者管理方面的挑战.
研究的目的:
- 分析抗血栓治疗 (ATT) 和其逆转策略对患有下皮血瘤 (SDH) 的患者手术结果的影响.
- 突出当前的管理挑战,并为神经外科干预提供最佳的外科手术期间的ATT策略.
主要方法:
- 100名接受紧急SDH疏散的患者的回顾性队列分析.
- 基于手术前ATT使用和接受逆转剂的分层.
- 统计分析包括千平方,t测试和逻辑回归;主要结果:死亡率;二次结果:SDH再扩张,修复手术,神经改善,血栓栓塞.
主要成果:
- 48%的患者接受了ATT,54.2%接受了逆转剂.
- 使用ATT与神经改善的减少 (p=0.023) 和增加死亡率的趋势 (p=0.078),SDH重新扩张 (p=0.12) 和修复手术 (p=0.10) 相相关.
- ATT逆转没有显著改善治疗结果,只能减少ICU停留时间 (p=0.014);11.5%的患者经历了术后血栓塞栓症.
结论:
- 术前ATT使用与非选择性SDH疏散的不良临床结果有关,不管是否尝试逆转.
- 加强了在高风险人群中明智使用ATT和优化逆转策略的需要.
- 强调多学科团队的重要性和不断发展的临床指导方针来管理神经外科患者的ATT.
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