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在接受急性A型大动脉剖析近端大动脉手术的患者中,下肢阻流综合征
Irsa Hasan1, James A Brown1, Derek Serna-Gallegos1,2
1Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa.
JTCVS open
|October 9, 2023
概括
患有A型大动脉解剖和下肢输血的患者面临更糟糕的生存率. 重血管化并不总是必要的,因为那些接受和不接受它的人的结果是相似的.
科学领域:
- 心血管外科心血管外科
- 血管外科 血管外科
- 主动脉疾病 主动脉疾病
背景情况:
- 下肢阻流是A型大动脉剖析的一个严重并发症.
- 关于这种特定患者群体的管理和结果的数据有限.
研究的目的:
- 为了比较患有急性A型大动脉解剖和下肢输血,有或没有再血管化的患者的结果.
- 识别与下肢不输血和死亡率相关的因素.
主要方法:
- 对601名患者的回顾性分析,这些患者在急性A型大动脉剖析中接受近道大动脉修复.
- 在患有和没有下肢输血的患者之间比较术后变量.
- 考克斯回归和Firth的惩罚性概率建模来确定相关因素.
主要成果:
- 14%的患者出现了下肢阻 perfusion,与男性性别,大动脉功能不充分,下射分数和其他阻 perfusion综合征相关.
- 下肢阻流与1,5年和10年生存率显著降低有关.
- 18%的下肢输血患者接受了再血管化,与没有再血管化的患者相比,结果没有显著差异.
结论:
- 甲型大动脉剖析与下肢输血相关,总体生存率较差.
- 在这个患者队列中,对于下肢输血不必要的再血管化并不普遍要求.
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